Provider Demographics
NPI:1679099964
Name:OSTROWSKI, SAMUEL (PTA)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:
Last Name:OSTROWSKI
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:COBLESKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12043-5144
Mailing Address - Country:US
Mailing Address - Phone:518-254-3261
Mailing Address - Fax:
Practice Address - Street 1:178 GRANDVIEW DR
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-5144
Practice Address - Country:US
Practice Address - Phone:518-254-3261
Practice Address - Fax:518-254-3335
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002244-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant