Provider Demographics
NPI:1710155833
Name:PHYSICAL THERAPY OF BROOKLYN PLLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY OF BROOKLYN PLLC
Other - Org Name:EXCEL PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVISON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-645-4120
Mailing Address - Street 1:2914 AVENUE R
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2524
Mailing Address - Country:US
Mailing Address - Phone:718-645-4120
Mailing Address - Fax:718-645-4101
Practice Address - Street 1:2914 AVENUE R
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2524
Practice Address - Country:US
Practice Address - Phone:718-645-4120
Practice Address - Fax:718-645-4101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0084931225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty