MEDICARE: PHYSICAL THERAPY OF THE BRONX

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	013186	NY
2	225100000X	Physical Therapist	3782	NY

General Provider Information

NPI Number	:	1568761971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY OF THE BRONX

Provider Business Mailing Address
First Line	:	813 SOUTHERN BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459-5202
Country	:	US
Telephone Number	:	718-861-6787
Fax Number	:

Provider Business Practice Location Address
First Line	:	813 SOUTHERN BLVD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10459-5202
Country	:	US
Telephone Number	:	718-861-6787
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MR. HOWARD GUSTAV KREBAUM JR.
Credential	:	PT
Telephone Number	:	718-861-6787

Provider Enumeration Date	:	03/24/2011
Last Update Date	:	03/24/2011

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Directions to “PHYSICAL THERAPY OF THE BRONX ” Practice Location

Language	Start Address	Practice Location

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