Provider Demographics
NPI:1689855827
Name:PAGE ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PAGE ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT,MS,ATC,CSCS
Authorized Official - Phone:607-622-5383
Mailing Address - Street 1:323 W WASHINGTON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1017
Mailing Address - Country:US
Mailing Address - Phone:607-622-5383
Mailing Address - Fax:607-622-5386
Practice Address - Street 1:323 W WASHINGTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1017
Practice Address - Country:US
Practice Address - Phone:607-622-5383
Practice Address - Fax:607-622-5386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0247801174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty