Provider Demographics
NPI:1073819843
Name:FUN IN AGING PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:FUN IN AGING PHYSICAL THERAPY, PC
Other - Org Name:FUN IN AGING, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEIGLER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-286-3889
Mailing Address - Street 1:2227 COUNTY ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:NY
Mailing Address - Zip Code:13646-4116
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2227 COUNTY ROUTE 6
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:NY
Practice Address - Zip Code:13646-4116
Practice Address - Country:US
Practice Address - Phone:315-286-3889
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014376-12251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatricsGroup - Single Specialty