MEDICARE: GREG JOHN SEBRING MPT

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	2251P0200X	Pediatric Physical Therapist	025645	NY

General Provider Information

NPI Number	:	1912159922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREG JOHN SEBRING MPT

Provider Business Mailing Address
First Line	:	PO BOX 360
Second Line	:
City	:	MOUNT KISCO
State	:	NY
Zip	:	10549-0360
Country	:	US
Telephone Number	:	716-713-9838
Fax Number	:

Provider Business Practice Location Address
First Line	:	212 BROOK RD
Second Line	:
City	:	MAHOPAC
State	:	NY
Zip	:	10541-1106
Country	:	US
Telephone Number	:	716-713-9838
Fax Number	:

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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