MEDICARE: BRIGHT S.I. PHYSICAL THERAPY P.C

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	014113	NY

General Provider Information

NPI Number	:	1922495910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT S.I. PHYSICAL THERAPY P.C

Provider Business Mailing Address
First Line	:	2052 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2583
Country	:	US
Telephone Number	:	718-351-2160
Fax Number	:	718-667-7279

Provider Business Practice Location Address
First Line	:	2052 RICHMOND RD
Second Line	:
City	:	STATEN ISLAND
State	:	NY
Zip	:	10306-2583
Country	:	US
Telephone Number	:	718-351-2160
Fax Number	:	718-667-7279

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MAGDY MOHAMMED ELMADBOLY
Credential	:	PHYSICAL THERAPIST
Telephone Number	:	718-351-2160

Provider Enumeration Date	:	04/17/2015
Last Update Date	:	04/17/2015

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