Provider Demographics
NPI:1629105481
Name:LATTIMORE OF GENESEO PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:LATTIMORE OF GENESEO PHYSICAL THERAPY PC
Other - Org Name: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 1:40 VILLAGE PLZ
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-9260
Mailing Address - Country:US
Mailing Address - Phone:585-335-2456
Mailing Address - Fax:585-335-3494
Practice Address - Street 1:40 VILLAGE PLZ
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-9260
Practice Address - Country:US
Practice Address - Phone:585-335-2456
Practice Address - Fax:585-335-3494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2019-04-25
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
AA0455Medicare UPIN
NYAA0455Medicare ID - Type Unspecified