MEDICARE: BERTA CONTRERAS

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	020529-1	NY

General Provider Information

NPI Number	:	1215181615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERTA CONTRERAS

Provider Business Mailing Address
First Line	:	45 S ELLIOTT PL
Second Line	:	4A
City	:	BROOKLYN
State	:	NY
Zip	:	11217-1286
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 S ELLIOTT PL
Second Line	:	4A
City	:	BROOKLYN
State	:	NY
Zip	:	11217-1286
Country	:	US
Telephone Number	:	917-450-1070
Fax Number	:

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

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	11/11/2008

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Directions to “ BERTA CONTRERAS ” Practice Location

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