Provider Demographics
NPI:1891980272
Name:PAGE ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:PAGE ORTHOPEDIC & SPORTS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:607-621-6157
Mailing Address - Street 1:323 W WASHINGTON ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:323 W WASHINGTON ST
Practice Address - Street 2:SUITE 201
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1017
Practice Address - Country:US
Practice Address - Phone:607-621-6157
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024780-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy