MEDICARE: NICHOLAS BYRNE PT, 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
1	225100000X	Physical Therapist	042618	NY

General Provider Information

NPI Number	:	1841704939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS BYRNE PT, DPT

Provider Business Mailing Address
First Line	:	2500 NESCONSET HWY BLDG 22B
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-2598
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 NESCONSET HWY BLDG 22B
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-2598
Country	:	US
Telephone Number	:	631-751-7988
Fax Number	:	631-751-7989

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

Provider Enumeration Date	:	11/28/2017
Last Update Date	:	11/28/2017

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