Provider Demographics
NPI:1629164629
Name:CORTLAND PHYSICAL THERAPY & SPORTS REHABILITATION
Entity Type:Organization
Organization Name:CORTLAND PHYSICAL THERAPY & SPORTS REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:M
Authorized Official - Last Name:CULLEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PT
Authorized Official - Phone:607-753-1055
Mailing Address - Street 1:8 KENNEDY PKWY
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1410
Mailing Address - Country:US
Mailing Address - Phone:607-753-1055
Mailing Address - Fax:607-753-1099
Practice Address - Street 1:8 KENNEDY PKWY
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1410
Practice Address - Country:US
Practice Address - Phone:607-753-1055
Practice Address - Fax:607-753-1099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
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
NY889502OtherAETNA
NY000910649001OtherHEALTH NOW
NY6600165OtherGHI
NY6699643OtherGHI
NY01240308Medicaid
NY889503OtherAETNA
NY000910648001OtherHEALTH NOW
NY01240317Medicaid
NY000910648001OtherHEALTH NOW
NY6600165OtherGHI