Provider Demographics
NPI:1881680692
Name:PHYSICAL THERAPY UNLIMITED OF SYRACUSE PC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY UNLIMITED OF SYRACUSE PC
Other - Org Name:CARMEN D RICCELLI PHYSICAL THERAPY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER / PT
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:J
Authorized Official - Last Name:YARAH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-487-8451
Mailing Address - Street 1:917 GRANGER RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13219-2165
Mailing Address - Country:US
Mailing Address - Phone:315-487-8451
Mailing Address - Fax:315-487-1552
Practice Address - Street 1:917 GRANGER RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13219-2165
Practice Address - Country:US
Practice Address - Phone:315-487-8451
Practice Address - Fax:315-487-1552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA0453Medicare ID - Type Unspecified