MEDICARE: MRS. MIRIAM CHAYA LIEBER - SEIF PT

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	015540-1	NY
2	225100000X	Physical Therapist	40QA00939300N	NJ
3	2251P0200X	Pediatric Physical Therapist	015540-1	NY

General Provider Information

NPI Number	:	1952556847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIRIAM CHAYA LIEBER - SEIF PT

Provider Business Mailing Address
First Line	:	38 MCNAMARA RD
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-1403
Country	:	US
Telephone Number	:	845-354-8115
Fax Number	:	845-354-0954

Provider Business Practice Location Address
First Line	:	38 MCNAMARA RD
Second Line	:
City	:	SPRING VALLEY
State	:	NY
Zip	:	10977-1403
Country	:	US
Telephone Number	:	845-354-8115
Fax Number	:	845-354-0954

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

Provider Enumeration Date	:	11/19/2008
Last Update Date	:	11/19/2008

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