Provider Demographics
NPI:1659915957
Name:OUTPATIENT PHYSICAL THERAPY AT HOME, PLLC
Entity Type:Organization
Organization Name:OUTPATIENT PHYSICAL THERAPY AT HOME, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:SUSANNE
Authorized Official - Last Name:BERG-SPINDELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:585-698-7200
Mailing Address - Street 1:4 CEDARWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-3246
Mailing Address - Country:US
Mailing Address - Phone:585-698-7200
Mailing Address - Fax:585-244-0664
Practice Address - Street 1:4 CEDARWOOD CIR
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-3246
Practice Address - Country:US
Practice Address - Phone:585-698-7200
Practice Address - Fax:585-244-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-30
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy