Basic Information
| Provider Information | |||||||||
| NPI: | 1558097170 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | REHABILITATION OF THE CITY PT PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8746 20TH AVE # L | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112144802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186480888 | ||||||||
| FaxNumber: | 8559553899 | ||||||||
| Practice Location | |||||||||
| Address1: | 8415 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112094654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186480888 | ||||||||
| FaxNumber: | 8559553899 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2022 | ||||||||
| LastUpdateDate: | 07/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | KHOULY | ||||||||
| AuthorizedOfficialFirstName: | MAHMOUD | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENT DEP | ||||||||
| AuthorizedOfficialTelephone: | 3475342516 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.