MEDICARE: SHREE HARIKRUSHAN PHYSICAL THERAPY 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	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1750870135
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHREE HARIKRUSHAN PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	60 N MADISON AVE
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-4811
Country	:	US
Telephone Number	:	845-414-9115
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 N MADISON AVE
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-4811
Country	:	US
Telephone Number	:	845-414-9115
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CHANDRASHEKHAR ARDESANA
Credential	:	PT
Telephone Number	:	973-722-7003

Provider Enumeration Date	:	05/01/2018
Last Update Date	:	05/01/2018

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