Provider Demographics
NPI:1154629715
Name:CLIFTON PARK PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:CLIFTON PARK PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:MARGARET
Authorized Official - Last Name:WANMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:518-383-2610
Mailing Address - Street 1:4 EMMA LN
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3763
Mailing Address - Country:US
Mailing Address - Phone:518-383-2610
Mailing Address - Fax:518-383-8118
Practice Address - Street 1:4 EMMA LN
Practice Address - Street 2:SUITE 401
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3763
Practice Address - Country:US
Practice Address - Phone:518-383-2610
Practice Address - Fax:518-383-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019934-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty