MEDICARE: MS. ROBERTA MAYER P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	6728	NY

General Provider Information

NPI Number	:	1578640967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROBERTA MAYER P.T.

Provider Business Mailing Address
First Line	:	370 S COUNTRY RD
Second Line	:
City	:	BROOKHAVEN
State	:	NY
Zip	:	11719-9768
Country	:	US
Telephone Number	:	631-286-0197
Fax Number	:

Provider Business Practice Location Address
First Line	:	152 ISLIP AVE
Second Line	:	SUITE 23
City	:	ISLIP
State	:	NY
Zip	:	11751-3225
Country	:	US
Telephone Number	:	631-277-6767
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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