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General NPI Number Information
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NPI Number | 1134478290
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Entity Type | Organization
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Legal Business Name | CREATIVE CARE PT PC
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Dates
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Enumeration Date | 09/05/2012
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Last Update Date | 09/05/2012
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Provider Practice Location Address
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Address Line | 11404 BEACH CHANNEL DR
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City | FAR ROCKAWAY
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State | NY
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Zip | 11694-2211
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Country | US
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Telephone | 718-945-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 8800 20TH AVE APARTMENT 3M
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City | BROOKLYN
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State | NY
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Zip | 11214-4849
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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 | PT
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Name | AMGAD SALIB MIKHAIL
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Credential |
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Telephone | 718-496-2726
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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 | 028129
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License Number State | MT
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