MEDICARE: DR. KRISTINA PHU DPT

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	04196201	NY

General Provider Information

NPI Number	:	1548761596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTINA PHU DPT

Provider Business Mailing Address
First Line	:	1239 BROADWAY
Second Line	:	STE 601
City	:	NEW YORK
State	:	NY
Zip	:	10001-4311
Country	:	US
Telephone Number	:	631-213-2394
Fax Number	:	212-898-0470

Provider Business Practice Location Address
First Line	:	200 PARK AVENUE
Second Line	:	GROUND FLOOR
City	:	NEW YORK
State	:	NY
Zip	:	11372
Country	:	US
Telephone Number	:	212-953-9494
Fax Number	:

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

Provider Enumeration Date	:	02/26/2018
Last Update Date	:	12/15/2020

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