MEDICARE: MICHAEL B COHEN 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	2251P0200X	Pediatric Physical Therapist	014273	NY
2	2251X0800X	Orthopedic Physical Therapist	014273	NY
3	2251S0007X	Sports Physical Therapist	014273	NY

General Provider Information

NPI Number	:	1235383530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL B COHEN P.T.

Provider Business Mailing Address
First Line	:	38 W PENN ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-4005
Country	:	US
Telephone Number	:	516-808-8258
Fax Number	:

Provider Business Practice Location Address
First Line	:	38 W PENN ST
Second Line	:
City	:	LONG BEACH
State	:	NY
Zip	:	11561-4005
Country	:	US
Telephone Number	:	516-808-8258
Fax Number	:

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

Provider Enumeration Date	:	11/13/2008
Last Update Date	:	11/13/2008

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