Provider Demographics
NPI:1124367651
Name:SCHUYLERVILLE PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:SCHUYLERVILLE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:FEAR
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:518-727-2096
Mailing Address - Street 1:43 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SCHUYLERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12871-1014
Mailing Address - Country:US
Mailing Address - Phone:518-595-9471
Mailing Address - Fax:
Practice Address - Street 1:43 SPRING ST
Practice Address - Street 2:
Practice Address - City:SCHUYLERVILLE
Practice Address - State:NY
Practice Address - Zip Code:12871-1014
Practice Address - Country:US
Practice Address - Phone:518-595-9471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023991-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty