MEDICARE: WELLNESS RIDGE PT 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1568326007
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLNESS RIDGE PT PC

Provider Business Mailing Address
First Line	:	1565 W 11TH ST APT 1R
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-6245
Country	:	US
Telephone Number	:	718-534-1251
Fax Number	:	347-812-0086

Provider Business Practice Location Address
First Line	:	1081 GATES AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-4303
Country	:	US
Telephone Number	:	718-534-1251
Fax Number	:	347-812-0086

Authorized Official
Title or Position	:	GROUP OWNER
Name	:	HASSAN ELAGATY
Credential	:
Telephone Number	:	551-216-3148

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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