# DEKHTYAREV PHYSICAL THERAPY PC

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

## Provider details

- **NPI number:** 1508099417
- **Authorized official:** DR. ALEKSANDR DEKHTYAREV DPT (PRESIDENT)
- **Authorized official phone:** 19175385175

## Contact information

- **Practice address:** 1811 QUENTIN RD, BROOKLYN, NY 11229-1343
- **Practice address phone:** (917) 538-5175
- **Mailing address:** 2044 E 18TH ST APT 2F, BROOKLYN, NY 11229-3836
- **Mailing address phone:** (917) 538-5175

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | 030526 | NY | Yes |

## Other

- **Enumeration date:** 08/26/2009
- **Last updated:** 08/26/2009