Provider Demographics
NPI:1962459594
Name:TLC REHABILITATION PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:TLC REHABILITATION PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:KEUNG
Authorized Official - Last Name:MUI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:718-463-6335
Mailing Address - Street 1:6501 BAY PARKWAY
Mailing Address - Street 2:C LEVEL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3948
Mailing Address - Country:US
Mailing Address - Phone:718-238-9392
Mailing Address - Fax:718-238-9379
Practice Address - Street 1:41-61 KISSENA BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3105
Practice Address - Country:US
Practice Address - Phone:718-463-6335
Practice Address - Fax:718-463-6087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03992OtherMEDICARE-GHI
NYQ9W301OtherMEDICARE PTAN
NY02350172Medicaid