Provider Demographics
NPI:1710315718
Name:CDK ABILITIES PHYSICAL THERAPY, SPEECH LANGUAGE PATHOLOGY
Entity Type:Organization
Organization Name:CDK ABILITIES PHYSICAL THERAPY, SPEECH LANGUAGE PATHOLOGY
Other - Org Name:DBA TINY HANDS ABILITIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PARTNER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCCSLP
Authorized Official - Phone:518-307-3494
Mailing Address - Street 1:25 BROOKFIELD RUN
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-8796
Mailing Address - Country:US
Mailing Address - Phone:518-307-3494
Mailing Address - Fax:518-541-2091
Practice Address - Street 1:100 MAPLE STREET
Practice Address - Street 2:
Practice Address - City:GLENSFALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3602
Practice Address - Country:US
Practice Address - Phone:518-307-3494
Practice Address - Fax:518-541-2091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006990252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03796458-CRMedicaid