Provider Demographics
NPI:1558320101
Name:ONTARIO PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ONTARIO PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPOREK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-524-9735
Mailing Address - Street 1:1272 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:NY
Mailing Address - Zip Code:14519-9101
Mailing Address - Country:US
Mailing Address - Phone:315-524-9735
Mailing Address - Fax:315-524-4423
Practice Address - Street 1:1272 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:NY
Practice Address - Zip Code:14519-9101
Practice Address - Country:US
Practice Address - Phone:315-524-9735
Practice Address - Fax:315-524-4423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000914253002OtherHEALTH NOW
NYP010088761OtherBLUES PROVIDER #
NY01555297Medicaid
NYP010088761OtherPOMCO
NY5225277OtherAENTA
NY103121FTOtherPREF CARE PROVIDER #
NY5225277OtherAENTA