MEDICARE: MR. JOHN KAROOR THOMAS MA 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	011242	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Q30261	OTHER	NY	MEDICARE

General Provider Information

NPI Number	:	1770726937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN KAROOR THOMAS MA PT

Provider Business Mailing Address
First Line	:	5811 HYLAN BLVD
Second Line	:	STATEN ISLAND
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3909
Country	:	US
Telephone Number	:	718-966-8651
Fax Number	:	718-966-2699

Provider Business Practice Location Address
First Line	:	5811 HYLAN BLVD
Second Line	:	STATEN ISLAND
City	:	STATEN ISLAND
State	:	NY
Zip	:	10309-3909
Country	:	US
Telephone Number	:	718-966-8651
Fax Number	:	718-966-2699

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

Provider Enumeration Date	:	04/16/2009
Last Update Date	:	04/16/2009

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Directions to “ MR. JOHN KAROOR THOMAS MA PT” Practice Location

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