MEDICARE: ARINA KOTLYARSKY MS, DPT

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	62026795	NY

General Provider Information

NPI Number	:	1396836854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARINA KOTLYARSKY MS, DPT

Provider Business Mailing Address
First Line	:	1900 E 22ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1527
Country	:	US
Telephone Number	:	917-340-1439
Fax Number	:	718-382-9010

Provider Business Practice Location Address
First Line	:	1900 E 22ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-1527
Country	:	US
Telephone Number	:	917-340-1439
Fax Number	:	718-382-9010

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	01/09/2008

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