MEDICARE: COMMUNITY PHYSICAL THERAPY OF BROOKLYN, 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	225100000X	Physical Therapist	021509	NY

General Provider Information

NPI Number	:	1326050980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMUNITY PHYSICAL THERAPY OF BROOKLYN, PLLC

Provider Business Mailing Address
First Line	:	1818 NEWKIRK AVE LBBY D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7359
Country	:	US
Telephone Number	:	718-859-2626
Fax Number	:	718-421-5391

Provider Business Practice Location Address
First Line	:	1818 NEWKIRK AVE LBBY D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-7359
Country	:	US
Telephone Number	:	718-859-2626
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MR. DAVID SOFER
Credential	:	PT
Telephone Number	:	718-859-2626

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	08/22/2020

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