Provider Demographics
NPI:1134312333
Name:PLATTSBURGH PHYSICAL THERAPY AND SPORTS REHAB
Entity Type:Organization
Organization Name:PLATTSBURGH PHYSICAL THERAPY AND SPORTS REHAB
Other - Org Name:CATSKILL ORTHOPEDICS AND SPORTS PHYSICAL THERAPY AND DBA MOUNTAIN PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WALEED
Authorized Official - Middle Name:S
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:845-796-2470
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:KIAMESHA LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12751-0130
Mailing Address - Country:US
Mailing Address - Phone:845-796-2470
Mailing Address - Fax:845-796-1420
Practice Address - Street 1:427 BROADWAY
Practice Address - Street 2:SUITE 3
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1742
Practice Address - Country:US
Practice Address - Phone:845-796-2470
Practice Address - Fax:845-796-1420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022824174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02622571Medicaid
NYA100000174Medicare PIN