MEDICARE: JHONNY DUMAN PTA

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	225200000X	Physical Therapy Assistant	010403	NY

General Provider Information

NPI Number	:	1578171542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JHONNY DUMAN PTA

Provider Business Mailing Address
First Line	:	2356 63RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3332
Country	:	US
Telephone Number	:	718-377-5000
Fax Number	:	718-377-5002

Provider Business Practice Location Address
First Line	:	2356 63RD ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11204-3332
Country	:	US
Telephone Number	:	718-377-5000
Fax Number	:	718-377-5002

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

Provider Enumeration Date	:	07/16/2020
Last Update Date	:	07/16/2020

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