Provider Demographics
NPI:1962494930
Name:MAURO-BERTOLO THERAPY SVCS PTPC
Entity Type:Organization
Organization Name:MAURO-BERTOLO THERAPY SVCS PTPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MAURO BERTOLO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-699-1009
Mailing Address - Street 1:6221 RTE 31
Mailing Address - Street 2:STE 103
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039
Mailing Address - Country:US
Mailing Address - Phone:315-699-1009
Mailing Address - Fax:315-699-1094
Practice Address - Street 1:6221 RTE 31
Practice Address - Street 2:STE 103
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039
Practice Address - Country:US
Practice Address - Phone:315-699-1009
Practice Address - Fax:315-699-1094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R55621Medicare UPIN
NY56332CMedicare ID - Type Unspecified