MEDICARE: ACTWELLNESS PHYSICAL THERAPY

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	0116021	NY

General Provider Information

NPI Number	:	1124578307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTWELLNESS PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	117 BAY 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4913
Country	:	US
Telephone Number	:	347-721-8905
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 BAY 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11214-4913
Country	:	US
Telephone Number	:	347-721-8905
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	IVAN STERN
Credential	:	RPT
Telephone Number	:	347-721-8905

Provider Enumeration Date	:	10/11/2016
Last Update Date	:	10/11/2016

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