=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770192346
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR T PHYSICAL THERAPY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/29/2020
-----------------------------------------------------
Last Update Date | 07/29/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 153 BAY 26TH ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11214-4938
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 347-702-9958
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1418 W 4TH ST APT 3A
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11204-4251
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-825-6644
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | DR. TARAS FRANKIVSKYY
-----------------------------------------------------
Credential | DPT, FAAOMPT
-----------------------------------------------------
Telephone | 917-825-6644
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------