MEDICARE: MR. GUILLERMO ECHANIQUE PT

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	003681-1	NY

General Provider Information

NPI Number	:	1275668691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GUILLERMO ECHANIQUE PT

Provider Business Mailing Address
First Line	:	70 PROSPECT PARK SW APT A6
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5981
Country	:	US
Telephone Number	:	917-670-7138
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 PROSPECT PARK SW APT A6
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11215-5981
Country	:	US
Telephone Number	:	917-670-7138
Fax Number	:

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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