Provider Demographics
NPI:1972721090
Name:PRESCRIPTION FITNESS PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:PRESCRIPTION FITNESS PHYSICAL THERAPY, P.C.
Other - Org Name:PRESCRIPTION FITNESS PHYSICAL THERAPY AND SPORTS CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:D
Authorized Official - Last Name:KERLAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:315-781-1010
Mailing Address - Street 1:515 WEST WASHINGTON STREET
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456
Mailing Address - Country:US
Mailing Address - Phone:315-781-1010
Mailing Address - Fax:315-781-1722
Practice Address - Street 1:515 WEST WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456
Practice Address - Country:US
Practice Address - Phone:315-781-1010
Practice Address - Fax:315-781-1722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2014-05-20
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
NYBA0084Medicare ID - Type UnspecifiedGROUP NUMBER