=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669779112
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREFERRED CARE PHYSICAL THERAPY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2011
-----------------------------------------------------
Last Update Date | 02/18/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 343 GOLD ST APT 907
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11201-3055
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-388-7491
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6040 82ND ST
-----------------------------------------------------
City | MIDDLE VILLAGE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11379-5335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-779-5588
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. FERDINAND DALUSONG GUARIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 718-779-5588
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number | 030254
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------