MEDICARE: MOBILECARE 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

General Provider Information

NPI Number	:	1114550373
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILECARE PHYSICAL THERAPY, PC

Provider Business Mailing Address
First Line	:	11059 63 AVE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1405
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11059 63 AVE
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-1405
Country	:	US
Telephone Number	:	917-561-2555
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER/OWNER
Name	:	DR. REGINA KHAIMOVA
Credential	:	DPT
Telephone Number	:	917-561-2555

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	02/17/2020

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