Provider Demographics
NPI:1821411802
Name:MAPLE CITY PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:MAPLE CITY PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:BITTEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-324-9344
Mailing Address - Street 1:55 BROADWAY MALL
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1919
Mailing Address - Country:US
Mailing Address - Phone:607-324-9344
Mailing Address - Fax:607-324-9345
Practice Address - Street 1:55 BROADWAY MALL
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1919
Practice Address - Country:US
Practice Address - Phone:607-324-9344
Practice Address - Fax:607-324-9345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-28
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023007261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy