MEDICARE: MARTHA JANE ISRAEL PHYSICAL THERAPIST

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	008909-1	NY

General Provider Information

NPI Number	:	1679883847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA JANE ISRAEL PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	6 HENRY CT
Second Line	:
City	:	MERRICK
State	:	NY
Zip	:	11566-2304
Country	:	US
Telephone Number	:	516-223-8679
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 HENRY CT
Second Line	:
City	:	MERRICK
State	:	NY
Zip	:	11566-2304
Country	:	US
Telephone Number	:	516-223-8679
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2010
Last Update Date	:	10/20/2010

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