Provider Demographics
NPI:1891818811
Name:SOUTHTOWNS PHYSICAL THERAPY GROUP PC
Entity Type:Organization
Organization Name:SOUTHTOWNS PHYSICAL THERAPY GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:R
Authorized Official - Last Name:RUH
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:716-675-4444
Mailing Address - Street 1:100 UNION RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-4656
Mailing Address - Country:US
Mailing Address - Phone:716-675-4444
Mailing Address - Fax:716-675-4446
Practice Address - Street 1:100 UNION RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-4656
Practice Address - Country:US
Practice Address - Phone:716-675-4444
Practice Address - Fax:716-675-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2013-07-24
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
NYAA0223Medicare ID - Type Unspecified