MEDICARE: TIAN EN SONG DPT

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	:	1952037947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIAN EN SONG DPT

Provider Business Mailing Address
First Line	:	3319 AVENUE N
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3319 AVENUE N STE 1
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-2605
Country	:	US
Telephone Number	:	718-258-3300
Fax Number	:

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

Provider Enumeration Date	:	08/01/2022
Last Update Date	:	12/04/2025

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