Provider Demographics
NPI:1841239522
Name:DOROTHEA B SOUTHWICK
Entity Type:Organization
Organization Name:DOROTHEA B SOUTHWICK
Other - Org Name:NORTH COUNTRY PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHEA
Authorized Official - Middle Name:B
Authorized Official - Last Name:SOUTHWICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:518-846-3900
Mailing Address - Street 1:9769 STATE RTE 9
Mailing Address - Street 2:PO BOX 216
Mailing Address - City:CHAZY
Mailing Address - State:NY
Mailing Address - Zip Code:12921-0216
Mailing Address - Country:US
Mailing Address - Phone:518-846-3900
Mailing Address - Fax:518-846-3900
Practice Address - Street 1:9769 STATE RTE 9
Practice Address - Street 2:
Practice Address - City:CHAZY
Practice Address - State:NY
Practice Address - Zip Code:12921-0216
Practice Address - Country:US
Practice Address - Phone:518-846-3900
Practice Address - Fax:518-846-3900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY=========OtherEMPIRE STATE PLAN GROUP
NY=========OtherEXCELLUS BLUE CROSS BLUE
NY=========OtherEMPIRE BC EMPIRE BCBS
NY=========OtherEMPIRE BC EMPIRE BCBS