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General NPI Number Information
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NPI Number | 1124522867
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Entity Type | Organization
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Legal Business Name | PROFIT REHAB PT PLLC
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 03/19/2018
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Provider Practice Location Address
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Address Line | 49 WEED AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10306-4922
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Country | US
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Telephone | 646-464-6757
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 620
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City | SYOSSET
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State | NY
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Zip | 11791-0620
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMGED GAD
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Credential | PT
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Telephone | 646-915-2549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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