Basic Information
| Provider Information | |||||||||
| NPI: | 1841270923 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SCOTT PHYSICAL THERAPY P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1514 VOORHIES AVENUE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NEW YORK | ||||||||
| PostalCode: | 11235 | ||||||||
| CountryCode: | UM | ||||||||
| TelephoneNumber: | 7186480888 | ||||||||
| FaxNumber: | 7186480411 | ||||||||
| Practice Location | |||||||||
| Address1: | 413 86TH ST | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112094707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189219721 | ||||||||
| FaxNumber: | 7189219349 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 09/26/2008 | ||||||||
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| AuthorizedOfficialLastName: | AMIR | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | EHUD | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7186480888 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 013940-1 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 20370P | 01 | NY | HIP | OTHER | 02458419 | 05 | NY | MEDICAID |