Provider Demographics
NPI:1477598845
Name:AUSTIN PHYSICAL THERAPY
Entity Type:Organization
Organization Name:AUSTIN PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:BELLONE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-539-4683
Mailing Address - Street 1:1282 WATERLOO GENEVA RD
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:NY
Mailing Address - Zip Code:13165-1208
Mailing Address - Country:US
Mailing Address - Phone:315-539-4683
Mailing Address - Fax:315-539-4684
Practice Address - Street 1:1282 WATERLOO GENEVA RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1208
Practice Address - Country:US
Practice Address - Phone:315-539-4683
Practice Address - Fax:315-539-4684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012318-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY100334FTOtherPREFERREDCARE GROUP #
NYP010012318OtherBLUE CHOICE GROUP NUMBER
NYP010012318OtherBLUE CHOICE GROUP NUMBER