Provider Demographics
NPI:1447587076
Name:CHURCHMAN, GILES C (PTA)
Entity Type:Individual
Prefix:MR
First Name:GILES
Middle Name:C
Last Name:CHURCHMAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1840
Mailing Address - Country:US
Mailing Address - Phone:607-382-5115
Mailing Address - Fax:
Practice Address - Street 1:411 CANISTEO ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-2104
Practice Address - Country:US
Practice Address - Phone:607-324-8280
Practice Address - Fax:607-324-8283
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY66007220225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant