MEDICARE: IN HOME PHYSICAL THERAPY 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	174400000X	Specialist

General Provider Information

NPI Number	:	1336895721
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IN HOME PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	475 NORTHERN BLVD STE 27
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-4802
Country	:	US
Telephone Number	:	516-344-0023
Fax Number	:	516-466-7723

Provider Business Practice Location Address
First Line	:	2024 DEER PARK AVE
Second Line	:
City	:	DEER PARK
State	:	NY
Zip	:	11729-3303
Country	:	US
Telephone Number	:	516-829-0030
Fax Number	:	516-466-7723

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	VINOD SOMAREDDY
Credential	:
Telephone Number	:	516-829-0030

Provider Enumeration Date	:	02/24/2022
Last Update Date	:	02/24/2022

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