MEDICARE: PRIME REHAB PT, 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	225100000X	Physical Therapist	024408	NY

General Provider Information

NPI Number	:	1952545394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME REHAB PT, PLLC

Provider Business Mailing Address
First Line	:	4809 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2213
Country	:	US
Telephone Number	:	718-686-1736
Fax Number	:	718-686-7098

Provider Business Practice Location Address
First Line	:	4809 8TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11220-2213
Country	:	US
Telephone Number	:	718-686-1736
Fax Number	:	718-686-7098

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	CATHERINE AFDAL
Credential	:
Telephone Number	:	718-686-1736

Provider Enumeration Date	:	04/29/2009
Last Update Date	:	05/01/2009

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