Provider Demographics
NPI:1083834758
Name:PHYSICAL THERAPY PROFESSIONALS, PC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY PROFESSIONALS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-346-0060
Mailing Address - Street 1:3506 THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14480-9730
Mailing Address - Country:US
Mailing Address - Phone:585-346-0060
Mailing Address - Fax:585-346-0108
Practice Address - Street 1:3506 THOMAS DR
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14480-9730
Practice Address - Country:US
Practice Address - Phone:585-346-0060
Practice Address - Fax:585-346-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012202225100000X
NY012242225100000X
NY017728225100000X
NY023289225100000X
NY018661225100000X
NY009223225100000X
NY026428225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100000121Medicare PIN