Provider Demographics
NPI:1457461006
Name:CAMILLUS PHYSICAL THERAPY AND SPORTS REHABILITATION
Entity Type:Organization
Organization Name:CAMILLUS PHYSICAL THERAPY AND SPORTS REHABILITATION
Other - Org Name:CNY PHYSICAL THERAPY AND AQUATIC CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:315-468-1050
Mailing Address - Street 1:5700 W GENESEE ST
Mailing Address - Street 2:STE 2S
Mailing Address - City:CAMILLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13031-3200
Mailing Address - Country:US
Mailing Address - Phone:315-468-1050
Mailing Address - Fax:315-468-1201
Practice Address - Street 1:5700 W GENESEE ST
Practice Address - Street 2:STE 2S
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-3200
Practice Address - Country:US
Practice Address - Phone:315-468-1050
Practice Address - Fax:315-468-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA1217Medicare ID - Type Unspecified