MEDICARE: ELLEN AND LAUREN 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

General Provider Information

NPI Number	:	1487242269
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLEN AND LAUREN PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	4470 21ST ST # 3129
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5114
Country	:	US
Telephone Number	:	347-968-2426
Fax Number	:

Provider Business Practice Location Address
First Line	:	4470 21ST ST # 3129
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11101-5114
Country	:	US
Telephone Number	:	347-968-2426
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELLEN CHANG
Credential	:
Telephone Number	:	347-968-2426

Provider Enumeration Date	:	01/06/2021
Last Update Date	:	02/21/2021

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