MEDICARE: PHYSICAL THERAPY REHABILITATION NEW YORK CITY, P.C.

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	252Y00000X	Early Intervention Provider Agency	0122141	NY

General Provider Information

NPI Number	:	1780077412
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHYSICAL THERAPY REHABILITATION NEW YORK CITY, P.C.

Provider Business Mailing Address
First Line	:	10008 87TH AVE
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-2017
Country	:	US
Telephone Number	:	917-741-4754
Fax Number	:	718-228-2820

Provider Business Practice Location Address
First Line	:	10008 87TH AVE
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-2017
Country	:	US
Telephone Number	:	917-741-4754
Fax Number	:	718-228-2820

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MS. CHERRY MANUEL CASTELLVI
Credential	:	PT
Telephone Number	:	917-741-4754

Provider Enumeration Date	:	03/05/2015
Last Update Date	:	03/05/2015

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