Provider Demographics
NPI:1659826212
Name:HOUSE CALL PHYSICAL THERAPY OF ROCHESTER PLLC
Entity Type:Organization
Organization Name:HOUSE CALL PHYSICAL THERAPY OF ROCHESTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:CORRIEA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:585-851-1771
Mailing Address - Street 1:53 WESTMAR DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-2535
Mailing Address - Country:US
Mailing Address - Phone:585-851-1771
Mailing Address - Fax:585-672-9030
Practice Address - Street 1:53 WESTMAR DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-2535
Practice Address - Country:US
Practice Address - Phone:585-851-1771
Practice Address - Fax:585-672-9030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022430261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1558574079OtherINDIVIDUAL NPI