Provider Demographics
NPI:1457669806
Name:INDEPENDENT PT CARE PC
Entity Type:Organization
Organization Name:INDEPENDENT PT CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:ATTYA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-676-2265
Mailing Address - Street 1:1723 ELM AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-5306
Mailing Address - Country:US
Mailing Address - Phone:718-676-2265
Mailing Address - Fax:718-676-2262
Practice Address - Street 1:1723 ELM AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-5306
Practice Address - Country:US
Practice Address - Phone:718-676-2265
Practice Address - Fax:718-676-2262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027668225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty