MEDICARE: BROOKLYN PHYSICAL THERAPY SERVICES, 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	261QP2000X	Physical Therapy Clinic/Center	005845-1	NY

General Provider Information

NPI Number	:	1073670220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKLYN PHYSICAL THERAPY SERVICES, PC

Provider Business Mailing Address
First Line	:	346 1ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-1906
Country	:	US
Telephone Number	:	718-788-2170
Fax Number	:	718-788-2214

Provider Business Practice Location Address
First Line	:	346 1ST ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-1906
Country	:	US
Telephone Number	:	718-788-2170
Fax Number	:	718-788-2214

Authorized Official
Title or Position	:	PRESIDENT-OWNER
Name	:	MR. JACQUES C AUGUSTIN
Credential	:	PT
Telephone Number	:	718-788-2170

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/31/2009

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