Provider Demographics
NPI:1922107960
Name:MICHAEL P. HUSON PT, LLC
Entity Type:Organization
Organization Name:MICHAEL P. HUSON PT, LLC
Other - Org Name:HUSON PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:HUSON
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-781-1144
Mailing Address - Street 1:675 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2119
Mailing Address - Country:US
Mailing Address - Phone:315-781-1144
Mailing Address - Fax:315-781-0169
Practice Address - Street 1:675 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2119
Practice Address - Country:US
Practice Address - Phone:315-781-1144
Practice Address - Fax:315-781-0169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023660-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY110751FTOtherPREFERRED CARE
NY470614OtherTUFTS
NY6698519OtherGHI
NY7211408OtherAETNA
NY6698519OtherGHI
NY470614OtherTUFTS