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General NPI Number Information
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NPI Number | 1366565616
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Entity Type | Individual
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Provider Name | MUHAMMAD IMRAN P.T.
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Gender | Male
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 700 PATCHOGUE YAPHANK RD STE 49
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City | MEDFORD
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State | NY
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Zip | 11763-2239
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Country | US
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Telephone | 631-775-7850
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Fax | 631-775-7850
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Provider Business Mailing Address
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Address Line | PO BOX 110
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City | PATCHOGUE
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State | NY
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Zip | 11772-0110
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Country | US
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Telephone | 631-775-7850
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Fax | 631-775-7850
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 019908-1
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License Number State | NY
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