MEDICARE: DR. NILES BRACY PT, DPT

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	045399	NY

General Provider Information

NPI Number	:	1912539719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NILES BRACY PT, DPT

Provider Business Mailing Address
First Line	:	1524 FIELDING ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10469-5904
Country	:	US
Telephone Number	:	347-527-6611
Fax Number	:

Provider Business Practice Location Address
First Line	:	153 W 27TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-6203
Country	:	US
Telephone Number	:	646-875-8348
Fax Number	:

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

Provider Enumeration Date	:	02/10/2020
Last Update Date	:	02/10/2020

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