MEDICARE: WISDOM PHYSICAL THERAPY PC

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	:	1386915643
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISDOM PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	200 BAY 49TH ST
Second Line	:	STE 3
City	:	BROOKLYN
State	:	NY
Zip	:	11214-7202
Country	:	US
Telephone Number	:	718-480-6794
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 BAY 49TH ST
Second Line	:	STE 3
City	:	BROOKLYN
State	:	NY
Zip	:	11214-7202
Country	:	US
Telephone Number	:	718-480-6794
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HATEM EL-SAID ABOU-HASSAN
Credential	:	PT
Telephone Number	:	718-480-6794

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	01/19/2012

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