Provider Demographics
NPI:1285180463
Name:PENN YAN PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:PENN YAN PHYSICAL THERAPY P.C.
Other - Org Name:LATTIMORE OF PENN YAN PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:585-315-2339
Mailing Address - Street 1:PO BOX 699
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-0699
Mailing Address - Country:US
Mailing Address - Phone:585-582-0007
Mailing Address - Fax:888-822-9237
Practice Address - Street 1:207 1/2 LAKE ST
Practice Address - Street 2:
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1802
Practice Address - Country:US
Practice Address - Phone:585-582-0007
Practice Address - Fax:888-822-9237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-29
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty