MEDICARE: MR. ERIC MUNIZ MS, PT

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	026874-1	NY
2	225100000X	Physical Therapist	7207	AZ

General Provider Information

NPI Number	:	1770537763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERIC MUNIZ MS, PT

Provider Business Mailing Address
First Line	:	152 72ND ST
Second Line	:	APT. 4C
City	:	BROOKLYN
State	:	NY
Zip	:	11209-2063
Country	:	US
Telephone Number	:	917-345-2043
Fax Number	:

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	:	05/22/2006
Last Update Date	:	07/08/2007

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