Provider Demographics
NPI:1760524144
Name:SARATOGA PHYSICAL THERAPY ASSOC
Entity Type:Organization
Organization Name:SARATOGA PHYSICAL THERAPY ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMATTEO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:518-587-5670
Mailing Address - Street 1:5 CARE LANE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866
Mailing Address - Country:US
Mailing Address - Phone:518-587-5670
Mailing Address - Fax:518-587-5674
Practice Address - Street 1:5 CARE LANE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866
Practice Address - Country:US
Practice Address - Phone:518-587-5670
Practice Address - Fax:518-587-5674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5650699911078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00635901Medicaid
AA0591Medicare ID - Type Unspecified
R55584Medicare UPIN