Provider Demographics
NPI:1326011453
Name:STOCKWIN, JOHN M (PT)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:STOCKWIN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5496 E TAFT RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:NORTH SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-3784
Mailing Address - Country:US
Mailing Address - Phone:315-451-6541
Mailing Address - Fax:315-451-7059
Practice Address - Street 1:1259 FISHER AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1012
Practice Address - Country:US
Practice Address - Phone:607-756-7991
Practice Address - Fax:607-756-5487
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY024388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5464900002OtherMEDICARE DME REGION A
NYP00371929OtherRAILROAD MEDICARE
NY000145609OtherBCBS CNY
NYDD5106Medicare PIN