MEDICARE: MR. GREGORY PAUL RAKOWSKI PT

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	0141941	NY
2	2251X0800X	Orthopedic Physical Therapist	0141941	NY

General Provider Information

NPI Number	:	1053578187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GREGORY PAUL RAKOWSKI PT

Provider Business Mailing Address
First Line	:	104 YONKERS AVE
Second Line	:
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-3911
Country	:	US
Telephone Number	:	914-282-2559
Fax Number	:	480-287-8653

Provider Business Practice Location Address
First Line	:	22 W 21ST ST
Second Line	:	#400 - SPORTS MED AT CHELSEA
City	:	NEW YORK
State	:	NY
Zip	:	10010-6904
Country	:	US
Telephone Number	:	914-282-2559
Fax Number	:	480-287-8653

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

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	06/22/2011

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