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NPI Code Detail

MEDICARE: BRILLIANT HEALTH SERVICES

MEDICARE: BRILLIANT HEALTH SERVICES
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
12251E1200XErgonomics Physical Therapist
22251S0007XSports Physical Therapist
3225700000XMassage Therapist
4225100000XPhysical Therapist

General Provider Information

NPI Number : 1629480793
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRILLIANT HEALTH SERVICES
Provider Business Mailing Address
First Line : 1560 BROADWAY 10TH FL
Second Line : SUITE 1007
City : NEW YORK
State : NY
Zip : 10036
Country : US
Telephone Number : 212-333-7224
Fax Number :
Provider Business Practice Location Address
First Line : 1560 BROADWAY FL 10
Second Line : SUITE 1007
City : NEW YORK
State : NY
Zip : 10036-1537
Country : US
Telephone Number : 212-333-7224
Fax Number :
Authorized Official
Title or Position : DIRECTOR
Name : LISA GEMMEL
Credential : P.T.
Telephone Number : 212-333-7224
Provider Enumeration Date : 05/23/2014
Last Update Date : 05/23/2014

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Directions to “BRILLIANT HEALTH SERVICES ” Practice Location

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