MEDICARE: BODY REPAIR PHYSICAL THERAPY 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	024831	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053500827
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY REPAIR PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	82-11 37TH AVE
Second Line	:	SUITE 602
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7015
Country	:	US
Telephone Number	:	718-932-1818
Fax Number	:	718-932-3222

Provider Business Practice Location Address
First Line	:	82-11 37TH AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-7015
Country	:	US
Telephone Number	:	718-932-1818
Fax Number	:	718-932-3222

Authorized Official
Title or Position	:	OWNER
Name	:	MS. GLORIA ZAPATA
Credential	:	P.T.
Telephone Number	:	718-932-1818

Provider Enumeration Date	:	10/17/2007
Last Update Date	:	09/19/2014

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