Provider Demographics
NPI:1518491349
Name:CANANDAIGUA PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:CANANDAIGUA PHYSICAL THERAPY P.C.
Other - Org Name:LATTIMORE OF VICTOR PT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITBOURNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-851-9987
Mailing Address - Street 1:20 ASSEMBLY DR STE 101
Mailing Address - Street 2:PO BOX 699
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-9609
Mailing Address - Country:US
Mailing Address - Phone:585-924-3250
Mailing Address - Fax:585-924-5127
Practice Address - Street 1:7387 PITTSFORD VICTOR RD STE 950
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9794
Practice Address - Country:US
Practice Address - Phone:585-924-3250
Practice Address - Fax:585-924-5127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty