MEDICARE: BELLMORE PHYSICAL THERAPY PC

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	039561	NY

General Provider Information

NPI Number	:	1215470562
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLMORE PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	2566 JERUSALEM AVE
Second Line	:
City	:	N BELLMORE
State	:	NY
Zip	:	11710-1832
Country	:	US
Telephone Number	:	516-785-1667
Fax Number	:	516-785-1668

Provider Business Practice Location Address
First Line	:	2566 JERUSALEM AVE
Second Line	:
City	:	N BELLMORE
State	:	NY
Zip	:	11710-1832
Country	:	US
Telephone Number	:	516-785-1667
Fax Number	:	516-785-1668

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DARLENE SHANE
Credential	:
Telephone Number	:	516-785-1667

Provider Enumeration Date	:	11/18/2016
Last Update Date	:	11/18/2016

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