MEDICARE: PUMARADA PHYSICAL THERAPY SERVICES, 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	251E00000X	Home Health Agency	020030	NY

General Provider Information

NPI Number	:	1891095287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PUMARADA PHYSICAL THERAPY SERVICES, PC

Provider Business Mailing Address
First Line	:	126 HUNTER AVENUE
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703
Country	:	US
Telephone Number	:	631-669-0415
Fax Number	:	631-669-1455

Provider Business Practice Location Address
First Line	:	126 HUNTER AVE
Second Line	:
City	:	NORTH BABYLON
State	:	NY
Zip	:	11703-4602
Country	:	US
Telephone Number	:	631-669-0415
Fax Number	:	631-669-1455

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. REYLITO POLIQUIT PUMARADA
Credential	:	PT, DPT
Telephone Number	:	631-669-0415

Provider Enumeration Date	:	11/01/2010
Last Update Date	:	11/01/2010

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