Provider Demographics
NPI:1720036254
Name:HEENEY PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:HEENEY PHYSICAL THERAPY, PC
Other - Org Name:BENDER REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:518-877-8900
Mailing Address - Street 1:2 ROSELL DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-1400
Mailing Address - Country:US
Mailing Address - Phone:518-877-8900
Mailing Address - Fax:518-877-8908
Practice Address - Street 1:2 ROSELL DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-1400
Practice Address - Country:US
Practice Address - Phone:518-877-8900
Practice Address - Fax:518-877-8908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021435-1225100000X
NY022761-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1588666192OtherJOHN C BENDER, NPI
NY1043212681OtherJESSICA BENDER, NPI
NY1043212681OtherJESSICA BENDER, NPI
NYBA0246Medicare PIN
NYQ21425Medicare UPIN
NY1588666192OtherJOHN C BENDER, NPI
NYRA2772Medicare PIN