MEDICARE: RELIEVERS 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	261QR0400X	Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1467933838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RELIEVERS PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	28 LAKE DR W
Second Line	:
City	:	WAYNE
State	:	NJ
Zip	:	07470-5733
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2829 OCEAN PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-7869
Country	:	US
Telephone Number	:	929-253-2364
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAHMOUD ELSANAA
Credential	:
Telephone Number	:	929-253-2364

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	08/23/2018

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