Provider Demographics
NPI:1255952099
Name:NUNDA PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:NUNDA PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT/OWNER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EBERSOLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:585-468-2020
Mailing Address - Street 1:25 S WEST ST PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:NUNDA
Mailing Address - State:NY
Mailing Address - Zip Code:14517-9685
Mailing Address - Country:US
Mailing Address - Phone:585-468-2020
Mailing Address - Fax:585-468-5001
Practice Address - Street 1:25 S WEST ST
Practice Address - Street 2:
Practice Address - City:NUNDA
Practice Address - State:NY
Practice Address - Zip Code:14517-9685
Practice Address - Country:US
Practice Address - Phone:585-468-2020
Practice Address - Fax:585-468-5001
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NUNDA PHYSICAL THERAPY PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty