Provider Demographics
NPI:1114065174
Name:CANI PT OT SLP & PSYCHOLOGY PLLC
Entity Type:Organization
Organization Name:CANI PT OT SLP & PSYCHOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:PEMBERTON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-782-6126
Mailing Address - Street 1:19472 US ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5387
Mailing Address - Country:US
Mailing Address - Phone:315-782-6126
Mailing Address - Fax:315-782-3816
Practice Address - Street 1:19472 US ROUTE 11
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5387
Practice Address - Country:US
Practice Address - Phone:315-782-6126
Practice Address - Fax:315-782-3816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty