Provider Demographics
NPI:1619106051
Name:FREEDOM THERAPY , OT, PT & SLP, PLLC
Entity Type:Organization
Organization Name:FREEDOM THERAPY , OT, PT & SLP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BURGE
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:585-720-9608
Mailing Address - Street 1:2050 CLINTON AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5727
Mailing Address - Country:US
Mailing Address - Phone:585-720-9608
Mailing Address - Fax:585-720-5484
Practice Address - Street 1:2050 CLINTON AVE S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5727
Practice Address - Country:US
Practice Address - Phone:585-720-9608
Practice Address - Fax:585-720-5484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty