MEDICARE: RUTH GALLARDO VELASQUEZ P.T.

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	027956	NY

General Provider Information

NPI Number	:	1134200298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH GALLARDO VELASQUEZ P.T.

Provider Business Mailing Address
First Line	:	14824 BOOTH MEMORIAL AVENUE
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11355
Country	:	US
Telephone Number	:	718-434-0711
Fax Number	:	718-434-0712

Provider Business Practice Location Address
First Line	:	2019 NOSTRAND AVENUE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210
Country	:	US
Telephone Number	:	718-434-0711
Fax Number	:	718-434-0712

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	07/08/2007

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