MEDICARE: PHYSICAL THERAPY OF BROOKLYN PLLC

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	0084931	NY

General Provider Information

NPI Number	:	1710155833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY OF BROOKLYN PLLC

Provider Business Mailing Address
First Line	:	2914 AVENUE R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2524
Country	:	US
Telephone Number	:	718-645-4120
Fax Number	:	718-645-4101

Provider Business Practice Location Address
First Line	:	2914 AVENUE R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-2524
Country	:	US
Telephone Number	:	718-645-4120
Fax Number	:	718-645-4101

Authorized Official
Title or Position	:	OWNER
Name	:	MS. DIANE DAVISON
Credential	:	PT
Telephone Number	:	718-645-4120

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	02/11/2008

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