=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164714200
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SIBYLLE K. GARRETT, PHYSICAL THERAPY, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/09/2011
-----------------------------------------------------
Last Update Date | 05/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 27 DUNWOOD RD
-----------------------------------------------------
City | PORT WASHINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11050-1638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-508-6165
-----------------------------------------------------
Fax | 516-883-8289
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 27 DUNWOOD ROAD
-----------------------------------------------------
City | PORT WASHINGTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11050-1638
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-508-6165
-----------------------------------------------------
Fax | 516-883-8289
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. SIBYLLE K. GARRETT
-----------------------------------------------------
Credential | PHYSICAL THERAPIST
-----------------------------------------------------
Telephone | 516-508-6165
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 016799
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------