MEDICARE: VINCENT S POVLOSKI PT

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	020744	NY

General Provider Information

NPI Number	:	1447436167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT S POVLOSKI PT

Provider Business Mailing Address
First Line	:	4513 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2107
Country	:	US
Telephone Number	:	718-633-9191
Fax Number	:	718-633-6667

Provider Business Practice Location Address
First Line	:	4513 14TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2107
Country	:	US
Telephone Number	:	718-633-9191
Fax Number	:	718-633-6667

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

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	01/11/2008

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