MEDICARE: RED CORE PTPTA AND REHABILITATION PLLC

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	225200000X	Physical Therapy Assistant
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1275120149
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RED CORE PTPTA AND REHABILITATION PLLC

Provider Business Mailing Address
First Line	:	PO BOX 780173
Second Line	:
City	:	MASPETH
State	:	NY
Zip	:	11378-0173
Country	:	US
Telephone Number	:	718-509-9888
Fax Number	:	718-509-6144

Provider Business Practice Location Address
First Line	:	1718 PITKIN AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-6604
Country	:	US
Telephone Number	:	718-509-9888
Fax Number	:	718-509-6144

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	EDUARD KHO
Credential	:
Telephone Number	:	718-509-9888

Provider Enumeration Date	:	12/28/2020
Last Update Date	:	12/28/2020

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