MEDICARE: MR. HO JU-PITER LEE PTA

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	225200000X	Physical Therapy Assistant	011803	NY

General Provider Information

NPI Number	:	1124597869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HO JU-PITER LEE PTA

Provider Business Mailing Address
First Line	:	48 FREEDOM AVE
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10314-3704
Country	:	US
Telephone Number	:	718-887-1145
Fax Number	:

Provider Business Practice Location Address
First Line	:	214 W HOUSTON ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10014-4846
Country	:	US
Telephone Number	:	212-337-9400
Fax Number	:

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

Provider Enumeration Date	:	11/23/2018
Last Update Date	:	11/23/2018

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