MEDICARE: NYC EMPIRE 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	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1639847452
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NYC EMPIRE PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	167 BROOK ST
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-6422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	425 MADISON AVE FL 11
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-1134
Country	:	US
Telephone Number	:	212-227-7310
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KYLE WARNER
Credential	:
Telephone Number	:	212-227-7310

Provider Enumeration Date	:	09/06/2021
Last Update Date	:	09/06/2021

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