MEDICARE: SHORE PARKWAY PT PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1003697475
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHORE PARKWAY PT PC

Provider Business Mailing Address
First Line	:	2612 W 2ND ST APT 3B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-6316
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2612 W 2ND ST APT 3B
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11223-6316
Country	:	US
Telephone Number	:	929-370-4205
Fax Number	:

Authorized Official
Title or Position	:	PT,OWNER
Name	:	AHMED MAHROUS
Credential	:
Telephone Number	:	929-370-4205

Provider Enumeration Date	:	10/11/2023
Last Update Date	:	10/11/2023

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