=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548501943
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXPRESS REHAB CARE PT,PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2013
-----------------------------------------------------
Last Update Date | 04/13/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 372 AVENUE U SUITE LL3
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11223-4018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-372-1690
-----------------------------------------------------
Fax | 718-372-1691
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 372 AVENUE U SUITE LL3
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11223-4018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-372-1690
-----------------------------------------------------
Fax | 718-372-1691
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PT,DPT
-----------------------------------------------------
Name | MR. AYMAN HASSAN ELKHOULY
-----------------------------------------------------
Credential | PT,DPT
-----------------------------------------------------
Telephone | 718-709-6442
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 018447
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 013410
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------