MEDICARE: JAIME PHILIP P.T.

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	022947	NY

General Provider Information

NPI Number	:	1033251301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAIME PHILIP P.T.

Provider Business Mailing Address
First Line	:	400 N BROADWAY
Second Line	:	SUITE D
City	:	JERICHO
State	:	NY
Zip	:	11753-2113
Country	:	US
Telephone Number	:	516-827-9446
Fax Number	:	516-827-0042

Provider Business Practice Location Address
First Line	:	400 N BROADWAY
Second Line	:	SUITE D
City	:	JERICHO
State	:	NY
Zip	:	11753-2113
Country	:	US
Telephone Number	:	516-827-9446
Fax Number	:	516-827-0042

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

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	07/08/2007

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