MEDICARE: MISS JULIANNE MELISSA KHAN PT, 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	025527-1	NY

General Provider Information

NPI Number	:	1568689677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JULIANNE MELISSA KHAN PT, DPT

Provider Business Mailing Address
First Line	:	156 W 74TH ST
Second Line	:	APT C
City	:	NEW YORK
State	:	NY
Zip	:	10023-2304
Country	:	US
Telephone Number	:	212-380-1096
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 HUDSON YARDS FL 10
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-2170
Country	:	US
Telephone Number	:	646-422-5960
Fax Number	:

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

Provider Enumeration Date	:	04/19/2007
Last Update Date	:	04/08/2021

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