MEDICARE: MR. DAVID CRAIG SALZBERG 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	020505	NY
2	2251P0200X	Pediatric Physical Therapist	020505	NY

General Provider Information

NPI Number	:	1073768479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID CRAIG SALZBERG PT

Provider Business Mailing Address
First Line	:	56 CLARADON LN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2809
Country	:	US
Telephone Number	:	718-981-7647
Fax Number	:

Provider Business Practice Location Address
First Line	:	56 CLARADON LN
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10305-2809
Country	:	US
Telephone Number	:	718-981-7647
Fax Number	:

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

Provider Enumeration Date	:	11/26/2008
Last Update Date	:	11/26/2008

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