MEDICARE: TRICARE PHYSICAL THERAPY 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	174400000X	Specialist

General Provider Information

NPI Number	:	1578845137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRICARE PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	460 OLD POST RD
Second Line	:	SUITE 1C
City	:	BEDFORD
State	:	NY
Zip	:	10506-1070
Country	:	US
Telephone Number	:	914-234-8800
Fax Number	:	914-234-8803

Provider Business Practice Location Address
First Line	:	460 OLD POST RD
Second Line	:	SUITE 1C
City	:	BEDFORD
State	:	NY
Zip	:	10506-1070
Country	:	US
Telephone Number	:	914-234-8800
Fax Number	:	914-234-8803

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MARK SIRKIN
Credential	:	PT
Telephone Number	:	914-234-8800

Provider Enumeration Date	:	09/09/2011
Last Update Date	:	01/16/2021

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