MEDICARE: WHOLISTIC PHYSICAL THERAPY, PC

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	NYS 016861-1	NY

General Provider Information

NPI Number	:	1871781641
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHOLISTIC PHYSICAL THERAPY, PC

Provider Business Mailing Address
First Line	:	1591 ROUTE 22
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-4026
Country	:	US
Telephone Number	:	845-940-1050
Fax Number	:	845-940-1051

Provider Business Practice Location Address
First Line	:	1591 ROUTE 22
Second Line	:
City	:	BREWSTER
State	:	NY
Zip	:	10509-4026
Country	:	US
Telephone Number	:	845-940-1050
Fax Number	:	845-940-1051

Authorized Official
Title or Position	:	OWNER
Name	:	MR. SCOTT W VAN NIEKERK
Credential	:	P.T.
Telephone Number	:	845-940-1050

Provider Enumeration Date	:	10/05/2007
Last Update Date	:	03/19/2015

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Practice Location Address:

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