MEDICARE: HEADSTART PHYSICAL THERAPY REHABILITATION

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	031230	NY

General Provider Information

NPI Number	:	1225318165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEADSTART PHYSICAL THERAPY REHABILITATION

Provider Business Mailing Address
First Line	:	5422 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4037
Country	:	US
Telephone Number	:	917-968-6605
Fax Number	:

Provider Business Practice Location Address
First Line	:	5422 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-4037
Country	:	US
Telephone Number	:	917-968-6605
Fax Number	:

Authorized Official
Title or Position	:	CO-OWNER/ PHYSICAL THERAPIST
Name	:	DR. ERIC TAMIR
Credential	:	DPT
Telephone Number	:	917-968-6605

Provider Enumeration Date	:	08/23/2011
Last Update Date	:	08/23/2011

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Directions to “HEADSTART PHYSICAL THERAPY REHABILITATION ” Practice Location

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