MEDICARE: SARAH WHITESIDE 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	:	1881289551
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARAH WHITESIDE PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	1502 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5602
Country	:	US
Telephone Number	:	718-768-0002
Fax Number	:	718-768-6720

Provider Business Practice Location Address
First Line	:	1502 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5602
Country	:	US
Telephone Number	:	718-768-0002
Fax Number	:	718-768-6720

Authorized Official
Title or Position	:	OWNER
Name	:	SARAH A WHITESIDE
Credential	:	DPT
Telephone Number	:	917-763-6839

Provider Enumeration Date	:	03/04/2021
Last Update Date	:	03/04/2021

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