Provider Demographics
NPI:1235176082
Name:ALPINE PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:ALPINE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:YASUO
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMIBAYASHI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-649-6574
Mailing Address - Street 1:60 JEFFERSON ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1122
Mailing Address - Country:US
Mailing Address - Phone:845-791-2737
Mailing Address - Fax:845-791-2738
Practice Address - Street 1:60 JEFFERSON ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1122
Practice Address - Country:US
Practice Address - Phone:845-791-2737
Practice Address - Fax:845-791-2738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016464-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ7W0D1Medicare ID - Type UnspecifiedMEDICARE PART B NO.