Provider Demographics
NPI:1003962523
Name:STAR PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:STAR PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPOTO
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DC, OCS
Authorized Official - Phone:585-425-1018
Mailing Address - Street 1:790 AYRAULT ROAD
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450
Mailing Address - Country:US
Mailing Address - Phone:585-425-1018
Mailing Address - Fax:585-425-8955
Practice Address - Street 1:790 AYRAULT ROAD
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450
Practice Address - Country:US
Practice Address - Phone:585-425-1018
Practice Address - Fax:585-425-8955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY103116FTOtherPREFILLED CARE
NYG0187891590OtherBLUE CHOICE
NY103116FTOtherPREFILLED CARE