Provider Demographics
NPI:1689922155
Name:HORSEHEADS COMPREHENSIVE PHYSICAL THERAPY, PC, CORP
Entity Type:Organization
Organization Name:HORSEHEADS COMPREHENSIVE PHYSICAL THERAPY, PC, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE/BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHAELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-795-1539
Mailing Address - Street 1:2758 WESTINGHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-8115
Mailing Address - Country:US
Mailing Address - Phone:607-795-1539
Mailing Address - Fax:607-795-1918
Practice Address - Street 1:2758 WESTINGHOUSE RD
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8115
Practice Address - Country:US
Practice Address - Phone:607-795-1539
Practice Address - Fax:607-795-1918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014843-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty