Provider Demographics
NPI:1689931461
Name:ONONDAGA PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ONONDAGA PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIS
Authorized Official - Middle Name:
Authorized Official - Last Name:RIGDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-635-5000
Mailing Address - Street 1:4524 PROVIDENCE RD
Mailing Address - Street 2:
Mailing Address - City:JAMESVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13078-6504
Mailing Address - Country:US
Mailing Address - Phone:315-635-5000
Mailing Address - Fax:315-679-5582
Practice Address - Street 1:11867 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:NY
Practice Address - Zip Code:14590-1025
Practice Address - Country:US
Practice Address - Phone:315-635-5000
Practice Address - Fax:315-679-5582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-18
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1638Medicare UPIN