Provider Demographics
NPI:1154475739
Name:LEROY PHYSICAL THERAPY AND ATHLETIC TRAINING, PLLC
Entity Type:Organization
Organization Name:LEROY PHYSICAL THERAPY AND ATHLETIC TRAINING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:PRIVATERA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:585-768-4550
Mailing Address - Street 1:3 WEST AVENUE
Mailing Address - Street 2:
Mailing Address - City:LEROY
Mailing Address - State:NY
Mailing Address - Zip Code:14482
Mailing Address - Country:US
Mailing Address - Phone:585-768-4550
Mailing Address - Fax:585-768-2335
Practice Address - Street 1:3 WEST AVENUE
Practice Address - Street 2:
Practice Address - City:LEROY
Practice Address - State:NY
Practice Address - Zip Code:14482
Practice Address - Country:US
Practice Address - Phone:585-768-4550
Practice Address - Fax:585-768-2335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100007187Medicare PIN