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NPI Code Detail

MEDICARE: PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, P.C.

MEDICARE: PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, P.C.
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 Therapist

General Provider Information

NPI Number : 1619485331
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, P.C.
Provider Business Mailing Address
First Line : 576 BROADHOLLOW RD
Second Line :
City : MELVILLE
State : NY
Zip : 11747-5002
Country : US
Telephone Number : 631-359-5859
Fax Number : 631-396-0865
Provider Business Practice Location Address
First Line : 815 HUTCHINSON RIVER PKWY
Second Line :
City : BRONX
State : NY
Zip : 10465-1887
Country : US
Telephone Number : 718-819-6805
Fax Number :
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : KATHLEEN BRUSH
Credential :
Telephone Number : 631-359-5859
Provider Enumeration Date : 01/16/2018
Last Update Date : 04/02/2018

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Directions to “PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, P.C. ” Practice Location

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