MEDICARE: ROSCHELLE FIONA MCBEAN PTA

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	225200000X	Physical Therapy Assistant	0065921	NY

General Provider Information

NPI Number	:	1023130531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSCHELLE FIONA MCBEAN PTA

Provider Business Mailing Address
First Line	:	228 E 92ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-1470
Country	:	US
Telephone Number	:	718-485-5394
Fax Number	:

Provider Business Practice Location Address
First Line	:	10322 ROCKAWAY BEACH BLVD
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-2744
Country	:	US
Telephone Number	:	718-318-8550
Fax Number	:	718-318-0607

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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