Provider Demographics
NPI:1023027935
Name:NORTH COUNTRY PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:NORTH COUNTRY PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:GABRIEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MS
Authorized Official - Phone:518-695-4072
Mailing Address - Street 1:336 STATE ROUTE 29
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GREENWICH
Mailing Address - State:NY
Mailing Address - Zip Code:12834-4518
Mailing Address - Country:US
Mailing Address - Phone:518-695-4072
Mailing Address - Fax:518-695-4866
Practice Address - Street 1:336 STATE ROUTE 29
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENWICH
Practice Address - State:NY
Practice Address - Zip Code:12834-4518
Practice Address - Country:US
Practice Address - Phone:518-695-4072
Practice Address - Fax:518-695-4866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56309BMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER