Provider Demographics
NPI:1477782589
Name:CHITTENANGO PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:CHITTENANGO PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENOIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-510-3372
Mailing Address - Street 1:1398 ROUTE 5 W
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037
Mailing Address - Country:US
Mailing Address - Phone:315-510-3372
Mailing Address - Fax:315-510-3688
Practice Address - Street 1:1398 ROUTE 5 W
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037
Practice Address - Country:US
Practice Address - Phone:315-510-3372
Practice Address - Fax:315-510-3688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-09
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
6312360001OtherMEDICARE DME
NYJ100000252OtherPTAN