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NPI Code Detail

MEDICARE: KELLY TERESA BERKOWSKY DPT

MEDICARE: KELLY TERESA BERKOWSKY 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
1225100000XPhysical Therapist031937NY

General Provider Information

NPI Number : 1760797997
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY TERESA BERKOWSKY DPT
Provider Business Mailing Address
First Line : 379 W CORTLAND AVE
Second Line :
City : OCEANSIDE
State : NY
Zip : 11572-4041
Country : US
Telephone Number : 917-709-7454
Fax Number :
Provider Business Practice Location Address
First Line : 49 MONTROSE AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11206-2580
Country : US
Telephone Number : 718-478-3808
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2010
Last Update Date : 10/02/2019

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