Basic Information
| Provider Information | |||||||||
| NPI: | 1609271998 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAGNA REHAB PHYSICAL THERAPY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2912 BRIGHTON 12TH ST STE 1 | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112354722 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189754334 | ||||||||
| FaxNumber: | 7189754337 | ||||||||
| Practice Location | |||||||||
| Address1: | 2184 FLATBUSH AVE | ||||||||
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| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112344326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186764446 | ||||||||
| FaxNumber: | 6466266401 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/29/2014 | ||||||||
| LastUpdateDate: | 10/30/2014 | ||||||||
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| AuthorizedOfficialLastName: | ABDEL-SHAHID | ||||||||
| AuthorizedOfficialFirstName: | REMONDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWENER | ||||||||
| AuthorizedOfficialTelephone: | 6464270353 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 026817 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.