MEDICARE: ROCKWELL GREY SUNCUACO BENNETT 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	030819	NY
2	225100000X	Physical Therapist	070.017489	IL

General Provider Information

NPI Number	:	1356671507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROCKWELL GREY SUNCUACO BENNETT PT

Provider Business Mailing Address
First Line	:	2129 25TH RD
Second Line	:	APT. 2
City	:	ASTORIA
State	:	NY
Zip	:	11102-3425
Country	:	US
Telephone Number	:	917-388-5059
Fax Number	:

Provider Business Practice Location Address
First Line	:	2129 25TH RD
Second Line	:	APT. 2
City	:	ASTORIA
State	:	NY
Zip	:	11102-3425
Country	:	US
Telephone Number	:	917-388-5059
Fax Number	:

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

Provider Enumeration Date	:	01/12/2010
Last Update Date	:	01/12/2010

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Directions to “ ROCKWELL GREY SUNCUACO BENNETT PT” Practice Location

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