MEDICARE: RIDGE ADVANCED 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	026874	NY

General Provider Information

NPI Number	:	1447397518
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIDGE ADVANCED PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	152 72ND ST
Second Line	:	APT 4C
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2063
Country	:	US
Telephone Number	:	917-345-2043
Fax Number	:

Provider Business Practice Location Address
First Line	:	482 78TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-3404
Country	:	US
Telephone Number	:	718-748-0864
Fax Number	:	718-748-0864

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	MR. ERIC MUNIZ
Credential	:	PT
Telephone Number	:	718-748-0864

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/22/2020

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