MEDICARE: PARK PHYSICAL THERAPY PLLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1134494529
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	5608 NEW UTRECHT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5608 NEW UTRECHT AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4631
Country	:	US
Telephone Number	:	718-673-5424
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	YEHUDA LITVINTCHOUK
Credential	:	DPT
Telephone Number	:	718-673-5424

Provider Enumeration Date	:	03/19/2012
Last Update Date	:	03/19/2012

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