Provider Demographics
NPI:1164478285
Name:PLAZA SPORTS MEDICINE & REHABILITATION PC
Entity Type:Organization
Organization Name:PLAZA SPORTS MEDICINE & REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:R
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-338-3070
Mailing Address - Street 1:ONE WHIPPLE LANE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622
Mailing Address - Country:US
Mailing Address - Phone:585-338-3070
Mailing Address - Fax:585-336-5014
Practice Address - Street 1:ONE WHIPPLE LANE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622
Practice Address - Country:US
Practice Address - Phone:585-338-3070
Practice Address - Fax:585-336-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy