Organization
ST JUDES PT
Active
Other names
St Judes PT- Pediatric Services
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEISHA E JOHN DPT (OWNER)
(718) 238-0311
Entity
Organization
Contact information
Practice address
212 MACON ST, 2ND FLOOR, BROOKLYN, NY 11216-2405
(718) 238-0311
Mailing address
7712 4TH AVE, FIRST FLOOR, BROOKLYN, NY 11209-3402
(718) 238-0311
Taxonomy
Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
028641
NY
225XP0200X
Pediatric Occupational Therapist
015866
NY
235Z00000X
Speech-Language Pathologist
—
NY
Other
Enumeration date
09/14/2011
Last updated
09/14/2011
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