MEDICARE: PROSOLUTION REHAB SERVICES OT PT PLLC

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
2	225X00000X	Occupational Therapist

General Provider Information

NPI Number	:	1043562937
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROSOLUTION REHAB SERVICES OT PT PLLC

Provider Business Mailing Address
First Line	:	100 CHERRY ST
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11001-3343
Country	:	US
Telephone Number	:	201-916-8442
Fax Number	:	516-616-0232

Provider Business Practice Location Address
First Line	:	100 CHERRY ST
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11001-3343
Country	:	US
Telephone Number	:	201-916-8442
Fax Number	:	516-616-0232

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. LEONID B YAGUDAYEV
Credential	:	OTR
Telephone Number	:	201-916-8442

Provider Enumeration Date	:	10/03/2012
Last Update Date	:	10/03/2012

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