Healthcare Provider Details

I. General information

NPI: 1811463003
Provider Name (Legal Business Name): PT AND OT FOR SENIOR REHAB AT HOME PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 06/27/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 KINGS HWY
BROOKLYN NY
11223-1023
US

IV. Provider business mailing address

171 KINGS HWY
BROOKLYN NY
11223-1023
US

V. Phone/Fax

Practice location:
  • Phone: 914-837-6538
  • Fax: 888-613-3109
Mailing address:
  • Phone: 914-837-6538
  • Fax: 888-613-3109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DAISY STEPHEN
Title or Position: VP
Credential:
Phone: 914-837-6538