Provider Demographics
NPI:1386027365
Name:BLUE SKY PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:BLUE SKY PHYSICAL THERAPY PC
Other - Org Name:HUDSON PHYSICAL THERAPY AND WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEESON
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:845-321-0498
Mailing Address - Street 1:5 TREELINE TER
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-4915
Mailing Address - Country:US
Mailing Address - Phone:845-321-0498
Mailing Address - Fax:
Practice Address - Street 1:265 N HIGHLAND AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1442
Practice Address - Country:US
Practice Address - Phone:845-321-0498
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022705-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty