Provider Demographics
NPI:1164586756
Name:CLARKSTOWN PHYSICAL THERAPY & SPORTS ASSOCIATES, LLP
Entity Type:Organization
Organization Name:CLARKSTOWN PHYSICAL THERAPY & SPORTS ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACKERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-627-6000
Mailing Address - Street 1:490 ROUTE 304
Mailing Address - Street 2:SE CORNER
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-3040
Mailing Address - Country:US
Mailing Address - Phone:845-639-6800
Mailing Address - Fax:845-639-6814
Practice Address - Street 1:490 ROUTE 304
Practice Address - Street 2:SE CORNER
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3040
Practice Address - Country:US
Practice Address - Phone:845-639-6800
Practice Address - Fax:845-639-6814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQAWYS1Medicare PIN