# PHYSIO DEVELOPMENT PT PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205613536
- **Authorized official:** MENNATALLAH IBRAHIM (OWNER)
- **Authorized official phone:** (646) 384-3095

## Contact information

- **Practice address:** 2270 GRAND AVE, BALDWIN, NY 11510-3163
- **Practice address phone:** (646) 384-3095
- **Mailing address:** 165 WESTWOOD DR APT 180, WESTBURY, NY 11590-1628
- **Mailing address phone:** (646) 384-3095

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 273Y00000X | Rehabilitation Hospital Unit | — | NULL | Yes |

## Other

- **Enumeration date:** 09/11/2023
- **Last updated:** 09/11/2023