MEDICARE: JACQUELINE SMALL

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	005840	NY

General Provider Information

NPI Number	:	1033833348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE SMALL

Provider Business Mailing Address
First Line	:	206 BELMONT PKWY
Second Line	:
City	:	HEMPSTEAD
State	:	NY
Zip	:	11550-6506
Country	:	US
Telephone Number	:	516-582-7714
Fax Number	:

Provider Business Practice Location Address
First Line	:	206 BELMONT PKWY
Second Line	:
City	:	HEMPSTEAD
State	:	NY
Zip	:	11550-6506
Country	:	US
Telephone Number	:	516-582-7714
Fax Number	:

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

Provider Enumeration Date	:	09/29/2022
Last Update Date	:	09/29/2022

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Directions to “ JACQUELINE SMALL ” Practice Location

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