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NPI Code Detail

MEDICARE: MARIE D PROKOPCHAK PT

MEDICARE: MARIE D PROKOPCHAK PT
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
1225100000XPhysical Therapist009324-1NY

General Provider Information

NPI Number : 1578704425
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIE D PROKOPCHAK PT
Provider Business Mailing Address
First Line : 44 FOX HILL DR
Second Line :
City : MIDDLETOWN
State : NY
Zip : 10940-8464
Country : US
Telephone Number : 845-355-7767
Fax Number :
Provider Business Practice Location Address
First Line : 379 MT HOPE RD
Second Line :
City : MIDDLETOWN
State : NY
Zip : 10940-7135
Country : US
Telephone Number : 845-344-2292
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2009
Last Update Date : 03/25/2009

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