Provider Demographics
NPI:1790234722
Name:RIDGEWAY PHYSICAL THERAPY AND CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:RIDGEWAY PHYSICAL THERAPY AND CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PHYSICAL THERAPIST, CHIROPRA
Authorized Official - Prefix:DR
Authorized Official - First Name:MICAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SUGARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DC
Authorized Official - Phone:585-471-5025
Mailing Address - Street 1:120 ERIE CANAL DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4607
Mailing Address - Country:US
Mailing Address - Phone:585-471-5025
Mailing Address - Fax:585-471-5553
Practice Address - Street 1:120 ERIE CANAL DR
Practice Address - Street 2:SUITE 130
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4607
Practice Address - Country:US
Practice Address - Phone:585-471-5025
Practice Address - Fax:585-471-5553
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011278111N00000X
NY031325225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400056744Medicare PIN