Provider Demographics
NPI:1811187636
Name:PLEASANT VALLEY PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PLEASANT VALLEY PHYSICAL THERAPY
Other - Org Name:HYDE PARK PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DIBERNARDO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:845-471-2423
Mailing Address - Street 1:1100 ROUTE 55
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LAGRANGEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12540
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4250 ALBANY POST ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538
Practice Address - Country:US
Practice Address - Phone:845-233-4960
Practice Address - Fax:845-233-4961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty