Provider Demographics
NPI:1114094919
Name:CLOVER PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:CLOVER PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:III
Authorized Official - Credentials:PT
Authorized Official - Phone:585-354-1590
Mailing Address - Street 1:7 LEEDS CIR
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-9428
Mailing Address - Country:US
Mailing Address - Phone:585-586-8867
Mailing Address - Fax:
Practice Address - Street 1:3019 MONROE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-4603
Practice Address - Country:US
Practice Address - Phone:585-354-1590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021702225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty