MEDICARE: ADVANCED PHYSICAL THERAPY

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	208100000X	Physical Medicine & Rehabilitation Physician	013057	NY

General Provider Information

NPI Number	:	1932289550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PHYSICAL THERAPY

Provider Business Mailing Address
First Line	:	6642 FOREST AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-3153
Country	:	US
Telephone Number	:	718-821-4216
Fax Number	:	718-821-4253

Provider Business Practice Location Address
First Line	:	6642 FOREST AVE
Second Line	:
City	:	RIDGEWOOD
State	:	NY
Zip	:	11385-3153
Country	:	US
Telephone Number	:	718-821-4216
Fax Number	:	718-821-4253

Authorized Official
Title or Position	:	OWNER
Name	:	MR. EFSTRATIOS ANTONIADIS
Credential	:	PT
Telephone Number	:	718-821-4216

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	06/16/2008

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1417961004 — MARIE FRANCES ANTONIADIS PT
Practice Location Address:

6642 FOREST AVE
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1871507707 — EFSTARTIOS ANTONIADIS PT
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Practice Fax:

1508860388 — DR. LEO MEIZLIK D.D.S.
Practice Location Address:

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1376541672 — DR. KAREN MARIE AGLIETTI DPM
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1467451229 — RIDGEWOOD DIALYSIS CENTER, INC
Practice Location Address:

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Directions to “ADVANCED PHYSICAL THERAPY ” Practice Location

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