MEDICARE: BARAKA PHYSICAL THERAPY LLC

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	025928	NY

General Provider Information

NPI Number	:	1215283221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARAKA PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	3347 91ST ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1749
Country	:	US
Telephone Number	:	347-495-2219
Fax Number	:

Provider Business Practice Location Address
First Line	:	3347 91ST ST
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1749
Country	:	US
Telephone Number	:	347-495-2219
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MS. MARY LUZ SANCHEZ
Credential	:	PT
Telephone Number	:	347-495-2219

Provider Enumeration Date	:	07/27/2012
Last Update Date	:	07/16/2015

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