Provider Demographics
NPI:1477783561
Name:PEDIATRIC PHYSICAL THERAPY SERVICES
Entity Type:Organization
Organization Name:PEDIATRIC PHYSICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SCHEFFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-727-4423
Mailing Address - Street 1:17 EDGEBROOK RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-1449
Mailing Address - Country:US
Mailing Address - Phone:607-727-4423
Mailing Address - Fax:607-723-9779
Practice Address - Street 1:17 EDGEBROOK RD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1449
Practice Address - Country:US
Practice Address - Phone:607-727-4423
Practice Address - Fax:607-723-9779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009480-1252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency