Provider Demographics
NPI:1942380969
Name:ADIRONDACK PHYSICAL AND OCCUPATIONAL THERAPY LLC
Entity Type:Organization
Organization Name:ADIRONDACK PHYSICAL AND OCCUPATIONAL THERAPY LLC
Other - Org Name:LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:MS,OTR/L
Authorized Official - Phone:315-207-2222
Mailing Address - Street 1:127 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2104
Mailing Address - Country:US
Mailing Address - Phone:315-207-2222
Mailing Address - Fax:315-343-6923
Practice Address - Street 1:127 E 1ST ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2104
Practice Address - Country:US
Practice Address - Phone:315-207-2222
Practice Address - Fax:315-343-6923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5212370001OtherMEDICARE NSC PTAN
NY5212370001OtherMEDICARE NSC PTAN