MEDICARE: MARTIN PREUSS 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
1	225100000X	Physical Therapist	019254-1	NY

General Provider Information

NPI Number	:	1881788255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN PREUSS PT

Provider Business Mailing Address
First Line	:	1 RYKOWSKI LN
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10941-4019
Country	:	US
Telephone Number	:	845-692-2225
Fax Number	:	845-692-2239

Provider Business Practice Location Address
First Line	:	1 RYKOWSKI LN
Second Line	:
City	:	MIDDLETOWN
State	:	NY
Zip	:	10941-4019
Country	:	US
Telephone Number	:	845-692-2225
Fax Number	:	845-692-2239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	12/05/2007

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