Provider Demographics
NPI:1710007182
Name:MENDON PHYSICAL THERAPY MANAGEMENT, PC
Entity Type:Organization
Organization Name:MENDON PHYSICAL THERAPY MANAGEMENT, PC
Other - Org Name:HONEOYE FALLS LIMA PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHUMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:585-582-1330
Mailing Address - Street 1:58 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HONEOYE FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14472-1042
Mailing Address - Country:US
Mailing Address - Phone:585-582-0034
Mailing Address - Fax:585-582-0026
Practice Address - Street 1:58 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HONEOYE FALLS
Practice Address - State:NY
Practice Address - Zip Code:14472-1042
Practice Address - Country:US
Practice Address - Phone:585-582-0034
Practice Address - Fax:585-582-0026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2015-01-08
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
NYAA0799Medicare UPIN