Provider Demographics
NPI:1952627044
Name:HOMER PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:HOMER PHYSICAL THERAPY, PC
Other - Org Name:HEYER PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EHREN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEYER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-749-2219
Mailing Address - Street 1:84 CORTLAND ST
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-1517
Mailing Address - Country:US
Mailing Address - Phone:607-749-2219
Mailing Address - Fax:607-749-2286
Practice Address - Street 1:84 CORTLAND ST
Practice Address - Street 2:
Practice Address - City:HOMER
Practice Address - State:NY
Practice Address - Zip Code:13077-1517
Practice Address - Country:US
Practice Address - Phone:607-749-2219
Practice Address - Fax:607-749-2286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-14
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0258401261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02565451Medicaid
NY56533AOtherUNSPECIFIED
NY56533AOtherUNSPECIFIED