MEDICARE: NY PHYSICAL THERAPY & WELLNESS, MELVILLE, PLLC

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	021022-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	173738P	OTHER	NY	HIP
2	Q13V52	OTHER	NY	BC/BS

General Provider Information

NPI Number	:	1659476968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NY PHYSICAL THERAPY & WELLNESS, MELVILLE, PLLC

Provider Business Mailing Address
First Line	:	1800 WALT WHITMAN RD STE 120
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-3237
Country	:	US
Telephone Number	:	631-694-0005
Fax Number	:	631-694-0007

Provider Business Practice Location Address
First Line	:	535 BROADHOLLOW RD
Second Line	:	SUITE A10
City	:	MELVILLE
State	:	NY
Zip	:	11747-3713
Country	:	US
Telephone Number	:	631-694-0005
Fax Number	:	631-694-0007

Authorized Official
Title or Position	:	PT / OWNER
Name	:	MR. RONALD J BREDOW
Credential	:	PT
Telephone Number	:	631-694-0005

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	03/05/2010

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