Provider Demographics
NPI:1508927906
Name:LAKESHORE PHYSICAL THERAPY
Entity Type:Organization
Organization Name:LAKESHORE PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOSSOM
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:585-227-3140
Mailing Address - Street 1:550 LATONA RD
Mailing Address - Street 2:BUILDING C
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2700
Mailing Address - Country:US
Mailing Address - Phone:585-227-3140
Mailing Address - Fax:585-225-7681
Practice Address - Street 1:550 LATONA RD
Practice Address - Street 2:BUILDING C
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2700
Practice Address - Country:US
Practice Address - Phone:585-227-3140
Practice Address - Fax:585-225-7681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0538Medicare PIN