MEDICARE: ADVANCE THERAPEUTIC CARE 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1619241221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE THERAPEUTIC CARE PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	5134 ROOSEVELT AVE
Second Line	:
City	:	WOODSIDE
State	:	NY
Zip	:	11377-4541
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4519 162ND ST STE 2
Second Line	:
City	:	FLUSHING
State	:	NY
Zip	:	11358-3137
Country	:	US
Telephone Number	:	347-400-0921
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FLORENCE B WOO
Credential	:
Telephone Number	:	347-400-0921

Provider Enumeration Date	:	02/28/2012
Last Update Date	:	02/28/2012

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