Provider Demographics
NPI:1508255761
Name:TRUMBLE PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:TRUMBLE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, OCS
Authorized Official - Phone:607-273-4972
Mailing Address - Street 1:840 HANSHAW RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1589
Mailing Address - Country:US
Mailing Address - Phone:607-273-4972
Mailing Address - Fax:607-273-4972
Practice Address - Street 1:840 HANSHAW RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1589
Practice Address - Country:US
Practice Address - Phone:607-273-4972
Practice Address - Fax:607-273-4972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013783261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1407926199OtherNPI - INDIVIDUAL
NY02309662Medicaid
NYDD0745OtherMEDICARE ID TYPE UNSPECIFIED
NY1407926199OtherNPI - INDIVIDUAL