MEDICARE: PRO-HEALTH PHYSICAL THERAPY SERVICES 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	225100000X	Physical Therapist	0189691	NY

General Provider Information

NPI Number	:	1174743017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRO-HEALTH PHYSICAL THERAPY SERVICES PLLC

Provider Business Mailing Address
First Line	:	840 E 8TH ST APT 5F
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-2748
Country	:	US
Telephone Number	:	917-749-3971
Fax Number	:

Provider Business Practice Location Address
First Line	:	2925 W 5TH ST STE 52
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11224-3962
Country	:	US
Telephone Number	:	917-749-3971
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	SERGEY YAROVOY
Credential	:
Telephone Number	:	917-749-3971

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	11/27/2022

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