Provider Demographics
NPI:1043225915
Name:BOUTON PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:BOUTON PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:R. CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-337-1436
Mailing Address - Street 1:221 S JAMES ST
Mailing Address - Street 2:BOUTON PHYSICAL THERAPY
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440
Mailing Address - Country:US
Mailing Address - Phone:315-337-1436
Mailing Address - Fax:315-336-1437
Practice Address - Street 1:221 S JAMES ST
Practice Address - Street 2:BOUTON PHYSICAL THERAPY
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440
Practice Address - Country:US
Practice Address - Phone:315-337-1436
Practice Address - Fax:315-336-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty