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General NPI Number Information
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NPI Number | 1487039905
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Entity Type | Organization
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Legal Business Name | CRESTWATER PHYSICAL THERAPY
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 07/27/2015
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Provider Practice Location Address
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Address Line | 7129 5TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-1678
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Country | US
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Telephone | 718-745-1313
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Fax |
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Provider Business Mailing Address
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Address Line | 7129 5TH AVE
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City | BROOKLYN
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State | NY
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Zip | 11209-1678
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Country | US
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Telephone | 718-745-1313
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAI ABDALLA
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Credential | DPT
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Telephone | 718-745-1313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 021464-1
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License Number State | NY
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