MEDICARE: GIMBO CORRE PHYSICAL THERAPY REHABILITATION SERVICES, 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1740886233
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIMBO CORRE PHYSICAL THERAPY REHABILITATION SERVICES, PC.

Provider Business Mailing Address
First Line	:	55 CLINTON RD
Second Line	:
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-6340
Country	:	US
Telephone Number	:	347-806-7706
Fax Number	:

Provider Business Practice Location Address
First Line	:	7708 BROADWAY
Second Line	:
City	:	ELMHURST
State	:	NY
Zip	:	11373-1927
Country	:	US
Telephone Number	:	347-806-7706
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	GIMBO JOHN O CORRE
Credential	:	PT
Telephone Number	:	347-806-7706

Provider Enumeration Date	:	12/09/2020
Last Update Date	:	05/11/2021

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