Provider Demographics
NPI:1730115015
Name:UPSTATE PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:UPSTATE PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEONARD.
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:585-387-0430
Mailing Address - Street 1:141 SULLYS TRL
Mailing Address - Street 2:SUITE 9
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4563
Mailing Address - Country:US
Mailing Address - Phone:585-387-0430
Mailing Address - Fax:585-387-0431
Practice Address - Street 1:141 SULLYS TRL
Practice Address - Street 2:SUITE 9
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4563
Practice Address - Country:US
Practice Address - Phone:585-387-0430
Practice Address - Fax:585-387-0431
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY05220-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0930Medicare ID - Type Unspecified