MEDICARE: MR. CHRIS PANDOLFI P.T.

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	020671	NY

General Provider Information

NPI Number	:	1225067226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CHRIS PANDOLFI P.T.

Provider Business Mailing Address
First Line	:	12 SESAME ST
Second Line	:
City	:	KINGS PARK
State	:	NY
Zip	:	11754-2836
Country	:	US
Telephone Number	:	631-987-3911
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 SESAME ST
Second Line	:
City	:	KINGS PARK
State	:	NY
Zip	:	11754-2836
Country	:	US
Telephone Number	:	631-987-3911
Fax Number	:

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

Provider Enumeration Date	:	07/02/2006
Last Update Date	:	06/17/2010

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