MEDICARE: ABUNDANCE PT P.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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1366312845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ABUNDANCE PT P.C.

Provider Business Mailing Address
First Line	:	333 HUGUENOT ST APT 1602
Second Line	:
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10801-7061
Country	:	US
Telephone Number	:	646-247-6060
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 HUGUENOT ST APT 1602
Second Line	:
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10801-7061
Country	:	US
Telephone Number	:	646-247-6060
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARY ROSE CUSTODIO
Credential	:
Telephone Number	:	646-247-6060

Provider Enumeration Date	:	11/10/2025
Last Update Date	:	11/10/2025

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