Provider Demographics
NPI:1336299700
Name:ON TRACK PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:ON TRACK PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOISVERT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-797-5414
Mailing Address - Street 1:120 PLAZA DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-3640
Mailing Address - Country:US
Mailing Address - Phone:607-797-5414
Mailing Address - Fax:607-797-6537
Practice Address - Street 1:120 PLAZA DR
Practice Address - Street 2:SUITE E
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-3640
Practice Address - Country:US
Practice Address - Phone:607-797-5414
Practice Address - Fax:607-797-6537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008038-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS791OtherCDPHP
NY6697064OtherGHI PPO
NY7782695OtherAETNA
NY166468OtherEXCELLUS
NY3949264OtherAETNA HMO
NY02721415Medicaid
NY=========OtherCIGNA
NY02721415Medicaid
NY3949264OtherAETNA HMO
NYS791OtherCDPHP