OrganizationPark Avenue Physical Therapy Pc(<Unavail>)Physical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address207 Hallock Rd Ste 209, Stony Brook, NY 11790-3082(631) 338-8516PECOS EnrollmentBased on the most recent information from CMS, provider Park Avenue Physical Therapy Pc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1982360038Provider TypeOrganizationFull NamePark Avenue Physical Therapy PcOther Name<Unavail>SubpartNoEnumeration Date11/12/2021Last Updated1/6/2024Contact InformationPractice LocationPractice Address207 Hallock Rd Ste 209, Stony Brook, NY 11790-3082Phone(631) 338-8516Fax(518) 984-3120Mailing LocationMailing Address207 Hallock Rd Ste 209, Stony Brook, NY 11790-3082Phone(631) 338-8516Fax(518) 984-3120Authorized OfficialNameKim, Jessie J (Owner)Phone(631) 338-8516Provider TaxonomiesCodeDescriptionLicenseCode225100000XPrimaryDescriptionPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicenseUnlisted Issuer