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General NPI Number Information
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NPI Number | 1699015156
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Entity Type | Organization
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Legal Business Name | KHAIRUL PEARSON, P.T.A., P.C.
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Dates
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Enumeration Date | 02/20/2013
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Last Update Date | 02/20/2013
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Provider Practice Location Address
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Address Line | 54 WELLSLEY LN
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City | CORAM
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State | NY
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Zip | 11727-1013
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Country | US
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Telephone | 631-680-1407
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1417
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City | ROCKY POINT
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State | NY
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Zip | 11778-1417
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST ASSISTANT
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Name | KHAIRUL PEARSON
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Credential | P.T.A.
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Telephone | 631-680-1407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 006564-1
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License Number State | NY
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