MEDICARE: HEATHER CASE P.T.

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	019462	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P3616785	OTHER	NY	OXFORD ID

General Provider Information

NPI Number	:	1780721423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER CASE P.T.

Provider Business Mailing Address
First Line	:	1560 BROADWAY
Second Line	:	SUITE 609
City	:	NEW YORK
State	:	NY
Zip	:	10036-1518
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1560 BROADWAY
Second Line	:	SUITE 609
City	:	NEW YORK
State	:	NY
Zip	:	10036-1518
Country	:	US
Telephone Number	:	212-938-0100
Fax Number	:

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

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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Directions to “ HEATHER CASE P.T.” Practice Location

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