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General NPI Number Information
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NPI Number | 1871786327
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL REHAB P.T., P.C.
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Dates
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Enumeration Date | 08/19/2007
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Last Update Date | 04/06/2015
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Provider Practice Location Address
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Address Line | 700 PATCHOGUE YAPHANK RD STE 49
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City | MEDFORD
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State | NY
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Zip | 11763-2239
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Country | US
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Telephone | 631-775-7580
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Fax | 631-775-7853
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Provider Business Mailing Address
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Address Line | 700 PATCHOGUE YAPHANK RD STE 49
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City | MEDFORD
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State | NY
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Zip | 11763-2239
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Country | US
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Telephone | 631-775-7850
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Fax | 631-775-7853
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Authorized Official
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Title or Position | PRESIDENT
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Name | MUHAMMAD IMRAN
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Credential | P.T.
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Telephone | 631-775-7850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 019908
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License Number State | NY
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