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General NPI Number Information
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NPI Number | 1245709310
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Entity Type | Organization
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Legal Business Name | RICHMOND COUNTY PHYSICAL THERAPY P.C
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Dates
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Enumeration Date | 11/19/2018
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Last Update Date | 11/19/2018
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Provider Practice Location Address
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Address Line | 581 5TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11215-8407
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Country | US
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Telephone | 718-965-0555
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Fax |
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Provider Business Mailing Address
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Address Line | 6A MCDIVITT AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10314-4962
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Country | US
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Telephone | 718-965-0555
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MOHAMED MOUSTAFA IBRAHIM
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Credential | DPT
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Telephone | 917-302-8341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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