Provider Demographics
NPI:1093983538
Name:DUANESBURG PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:DUANESBURG PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MAGIL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, MS, PT
Authorized Official - Phone:518-355-8500
Mailing Address - Street 1:4780 DUANESBURG ROAD
Mailing Address - Street 2:
Mailing Address - City:DUANESBURG
Mailing Address - State:NY
Mailing Address - Zip Code:12056
Mailing Address - Country:US
Mailing Address - Phone:518-355-8500
Mailing Address - Fax:518-355-8550
Practice Address - Street 1:4780 DUANESBURG ROAD
Practice Address - Street 2:
Practice Address - City:DUANESBURG
Practice Address - State:NY
Practice Address - Zip Code:12056
Practice Address - Country:US
Practice Address - Phone:518-355-8500
Practice Address - Fax:518-355-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-19
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025955261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA1342Medicare PIN