Provider Demographics
NPI:1558097170
Name:REHABILITATION OF THE CITY PT PC
Entity Type:Organization
Organization Name:REHABILITATION OF THE CITY PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENT DEP
Authorized Official - Prefix:
Authorized Official - First Name:MAHMOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOULY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-534-2516
Mailing Address - Street 1:8746 20TH AVE # L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-4802
Mailing Address - Country:US
Mailing Address - Phone:718-648-0888
Mailing Address - Fax:855-955-3899
Practice Address - Street 1:8415 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-4654
Practice Address - Country:US
Practice Address - Phone:718-648-0888
Practice Address - Fax:855-955-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty