Provider Demographics
NPI:1336641661
Name:CANANDAIGUA PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:CANANDAIGUA PHYSICAL THERAPY P.C.
Other - Org Name:LATTIMORE OF NORTH CHILI PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-851-9987
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:
Mailing Address - Fax:
Practice Address - Street 1:3237 UNION ST
Practice Address - Street 2:
Practice Address - City:NORTH CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514-1129
Practice Address - Country:US
Practice Address - Phone:585-594-1688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty