MEDICARE: BORO WELLNESS PHYSICAL THERAPY LLC

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

General Provider Information

NPI Number	:	1942780317
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BORO WELLNESS PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	4909 FORT HAMILTON PKWY STE A
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3372
Country	:	US
Telephone Number	:	347-627-9434
Fax Number	:	347-627-9435

Provider Business Practice Location Address
First Line	:	4909 FORT HAMILTON PKWY
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-3386
Country	:	US
Telephone Number	:	347-820-1495
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	MR. RONALD BUENAGUA RUSTIA
Credential	:	PT
Telephone Number	:	347-820-1495

Provider Enumeration Date	:	08/15/2018
Last Update Date	:	06/03/2026

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