MEDICARE: ASSEM 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	:	1417488578
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASSEM PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	5506 AVENUE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4006
Country	:	US
Telephone Number	:	347-492-4200
Fax Number	:	347-492-4080

Provider Business Practice Location Address
First Line	:	5506 AVENUE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4006
Country	:	US
Telephone Number	:	347-492-4200
Fax Number	:	347-492-4080

Authorized Official
Title or Position	:	OWNER
Name	:	ASSEM ALI AWAD
Credential	:	PT
Telephone Number	:	347-492-4200

Provider Enumeration Date	:	03/21/2017
Last Update Date	:	03/21/2017

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