MEDICARE: AMIR MAHROUS YOUNAN HANNA PT, DPT

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	04733101	NY

General Provider Information

NPI Number	:	1699464214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMIR MAHROUS YOUNAN HANNA PT, DPT

Provider Business Mailing Address
First Line	:	714 FOCH BLVD
Second Line	:
City	:	WILLISTON PARK
State	:	NY
Zip	:	11596-1010
Country	:	US
Telephone Number	:	516-216-0867
Fax Number	:

Provider Business Practice Location Address
First Line	:	6421 FRESH POND RD
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-3330
Country	:	US
Telephone Number	:	631-494-7572
Fax Number	:

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

Provider Enumeration Date	:	05/01/2023
Last Update Date	:	02/13/2024

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