Provider Demographics
NPI:1568405322
Name:RIVERSIDE PHYSICIAL & OCCUPATIONAL THERAPY LANGUAGE PATHOLOGY, PLLC
Entity Type:Organization
Organization Name:RIVERSIDE PHYSICIAL & OCCUPATIONAL THERAPY LANGUAGE PATHOLOGY, PLLC
Other - Org Name:THERAPY WORKS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:RACCOSTA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-896-4991
Mailing Address - Street 1:PO BOX 1151
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12602-1151
Mailing Address - Country:US
Mailing Address - Phone:845-896-4991
Mailing Address - Fax:845-896-0159
Practice Address - Street 1:17 OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1850
Practice Address - Country:US
Practice Address - Phone:845-896-4991
Practice Address - Fax:845-896-0159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQAW391Medicare ID - Type Unspecified