MEDICARE: PROFESSIONAL REHAB PHYSICAL THERAPY P.C.

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	030908	NY

General Provider Information

NPI Number	:	1104283761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL REHAB PHYSICAL THERAPY P.C.

Provider Business Mailing Address
First Line	:	130 BAY 10TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-3702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2184 FLATBUSH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4326
Country	:	US
Telephone Number	:	347-788-2430
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PROF. YASSER ABDALLA
Credential	:
Telephone Number	:	347-788-2430

Provider Enumeration Date	:	01/26/2016
Last Update Date	:	01/29/2016

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