MEDICARE: HIROSHI KIYOTA RPT

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	023642-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	023642-1	OTHER	NY	LICENSE NUMBER

General Provider Information

NPI Number	:	1699970624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HIROSHI KIYOTA RPT

Provider Business Mailing Address
First Line	:	710 PARKSIDE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-1508
Country	:	US
Telephone Number	:	718-282-7800
Fax Number	:	718-282-7838

Provider Business Practice Location Address
First Line	:	710 PARKSIDE AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11226-1508
Country	:	US
Telephone Number	:	718-282-7800
Fax Number	:	718-282-7838

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	02/06/2012

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