Provider Demographics
NPI:1659551778
Name:WARCHOL, JEREMY M (PT)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:M
Last Name:WARCHOL
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Gender:M
Credentials:PT
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Mailing Address - Street 1:203 STATE STREET
Mailing Address - Street 2:NORTHERN PHYSICAL THERAPY, PLLC
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669
Mailing Address - Country:US
Mailing Address - Phone:315-393-2024
Mailing Address - Fax:315-393-2025
Practice Address - Street 1:203 STATE STREET
Practice Address - Street 2:NORTHERN PHYSICAL THERAPY, PLLC
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669
Practice Address - Country:US
Practice Address - Phone:315-393-2024
Practice Address - Fax:315-393-2025
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY21580-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist