MEDICARE: GAME PLAN 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	2251X0800X	Orthopedic Physical Therapist

General Provider Information

NPI Number	:	1952072217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAME PLAN PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	104 BAY RIDGE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-5053
Country	:	US
Telephone Number	:	646-290-1169
Fax Number	:	212-223-0198

Provider Business Practice Location Address
First Line	:	104 BAY RIDGE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-5053
Country	:	US
Telephone Number	:	646-290-1169
Fax Number	:	212-223-0198

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	PAUL NASRI
Credential	:	PT
Telephone Number	:	646-290-1169

Provider Enumeration Date	:	09/25/2021
Last Update Date	:	09/25/2021

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