Provider Demographics
NPI:1083956064
Name:START PHYSICAL THERAPY AND PHYSICAL THERAPY ASSISTANT, PLLC
Entity Type:Organization
Organization Name:START PHYSICAL THERAPY AND PHYSICAL THERAPY ASSISTANT, PLLC
Other - Org Name:START PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIGGS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:315-487-8278
Mailing Address - Street 1:5415 W GENESEE ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-2162
Mailing Address - Country:US
Mailing Address - Phone:315-487-8278
Mailing Address - Fax:315-487-8273
Practice Address - Street 1:5415 W GENESEE ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-2162
Practice Address - Country:US
Practice Address - Phone:315-487-8278
Practice Address - Fax:315-487-8273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0268161225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty