Provider Demographics
NPI:1942639117
Name:PROCARE PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:PROCARE PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:585-545-4453
Mailing Address - Street 1:847 HOLT RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-9193
Mailing Address - Country:US
Mailing Address - Phone:585-545-4453
Mailing Address - Fax:585-625-2410
Practice Address - Street 1:847 HOLT RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-9193
Practice Address - Country:US
Practice Address - Phone:585-545-4453
Practice Address - Fax:585-625-2410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-07
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017206225100000X
NY016309225100000X
NY031592225100000X
NY007649225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC0435Medicare PIN