Provider Demographics
NPI:1225263536
Name:ONONDAGA PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ONONDAGA PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIS
Authorized Official - Middle Name:S
Authorized Official - Last Name:RIGDON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-635-5000
Mailing Address - Street 1:8390 OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13090-1002
Mailing Address - Country:US
Mailing Address - Phone:315-635-5000
Mailing Address - Fax:315-458-2975
Practice Address - Street 1:6265 STATE ROUTE 31
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-8751
Practice Address - Country:US
Practice Address - Phone:315-635-5000
Practice Address - Fax:315-458-2975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-17
Last Update Date:2024-02-08
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
NY02420024Medicaid
NYAA1638Medicare UPIN