Provider Demographics
NPI:1457322935
Name:R.J.N. PHYSICAL THERAPY P.L.L.C.
Entity Type:Organization
Organization Name:R.J.N. PHYSICAL THERAPY P.L.L.C.
Other - Org Name:R.J.N. PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WAITE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:518-489-2020
Mailing Address - Street 1:250 OLD LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2909
Mailing Address - Country:US
Mailing Address - Phone:518-489-2020
Mailing Address - Fax:518-489-0716
Practice Address - Street 1:250 OLD LOUDON RD
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2909
Practice Address - Country:US
Practice Address - Phone:518-489-2020
Practice Address - Fax:518-489-0716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012460225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0724Medicare ID - Type UnspecifiedGROUP PRACTICE #