MEDICARE: KELLEN RYAN SCANTLEBURY PHYSICAL THERAPY 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1720807928
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KELLEN RYAN SCANTLEBURY PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	2103 31ST AVE
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-4521
Country	:	US
Telephone Number	:	646-875-8348
Fax Number	:

Provider Business Practice Location Address
First Line	:	2103 31ST AVE
Second Line	:
City	:	ASTORIA
State	:	NY
Zip	:	11106-4521
Country	:	US
Telephone Number	:	646-875-8348
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KELLEN SCANTLEBURY
Credential	:	DPT
Telephone Number	:	646-875-8348

Provider Enumeration Date	:	10/07/2024
Last Update Date	:	10/07/2024

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