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NPI Code Detail

MEDICARE: PROFESSIONAL PT OT SERVICES P.L.L.C.

MEDICARE: PROFESSIONAL PT OT SERVICES P.L.L.C.
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
1225X00000XOccupational Therapist
2225100000XPhysical Therapist

General Provider Information

NPI Number : 1356981039
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROFESSIONAL PT OT SERVICES P.L.L.C.
Provider Business Mailing Address
First Line : 500 DEKALB AVE STE 401B
Second Line :
City : BROOKLYN
State : NY
Zip : 11205-5243
Country : US
Telephone Number : 516-667-8844
Fax Number : 718-228-5233
Provider Business Practice Location Address
First Line : 500 DEKALB AVE STE 401B
Second Line :
City : BROOKLYN
State : NY
Zip : 11205-5243
Country : US
Telephone Number : 516-667-8844
Fax Number : 718-228-5233
Authorized Official
Title or Position : DIRECTOR
Name : MR. IAN JOHN MAHASE
Credential : PT
Telephone Number : 516-667-8844
Provider Enumeration Date : 01/10/2020
Last Update Date : 12/23/2021

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Directions to “PROFESSIONAL PT OT SERVICES P.L.L.C. ” Practice Location

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