MEDICARE: DIRECT 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1366915068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIRECT PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	24 MAJOR APPLEBY RD
Second Line	:
City	:	ARDSLEY
State	:	NY
Zip	:	10502-1627
Country	:	US
Telephone Number	:	914-376-6100
Fax Number	:	914-470-5056

Provider Business Practice Location Address
First Line	:	24 MAJOR APPLEBY RD
Second Line	:
City	:	ARDSLEY
State	:	NY
Zip	:	10502-1627
Country	:	US
Telephone Number	:	914-376-6100
Fax Number	:	914-470-5056

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	MELISSA NIELI
Credential	:
Telephone Number	:	914-376-6100

Provider Enumeration Date	:	01/04/2019
Last Update Date	:	03/13/2019

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