Provider Demographics
NPI:1174673586
Name:DEMOREE, ARTHUR (PT)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:DEMOREE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:2563 WESTERN AVENUE
Mailing Address - City:GUILDERLAND
Mailing Address - State:NY
Mailing Address - Zip Code:12084-0069
Mailing Address - Country:US
Mailing Address - Phone:518-456-6097
Mailing Address - Fax:
Practice Address - Street 1:2563 WESTERN AVENUE
Practice Address - Street 2:
Practice Address - City:GUILDERLAND
Practice Address - State:NY
Practice Address - Zip Code:12084
Practice Address - Country:US
Practice Address - Phone:518-456-6097
Practice Address - Fax:518-456-3480
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009387225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02133457Medicaid
CC4582Medicare ID - Type Unspecified
NY02133457Medicaid