MEDICARE: MRS. KAMILA PISOVA-CHU 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	019052	NY

General Provider Information

NPI Number	:	1124286729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAMILA PISOVA-CHU PT

Provider Business Mailing Address
First Line	:	526 84TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-4702
Country	:	US
Telephone Number	:	718-812-4002
Fax Number	:

Provider Business Practice Location Address
First Line	:	670 6TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-6316
Country	:	US
Telephone Number	:	718-369-2560
Fax Number	:

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

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	05/30/2008

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