Provider Demographics
NPI:1619079860
Name:LATTIMORE OF GENESEO PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:LATTIMORE OF GENESEO PHYSICAL THERAPY PC
Other - Org Name:AVON PHYSICAL THERAPY, DANSVILLE PHYSICAL THERAPY
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:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:MENDON
Mailing Address - State:NY
Mailing Address - Zip Code:14506-0693
Mailing Address - Country:US
Mailing Address - Phone:585-851-9987
Mailing Address - Fax:866-299-5675
Practice Address - Street 1:4 EAST SOUTH ST
Practice Address - Street 2:
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454
Practice Address - Country:US
Practice Address - Phone:585-243-9150
Practice Address - Fax:585-243-4814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0455Medicare UPIN