Provider Demographics
NPI:1265546147
Name:PAGE, BRIAN (DPT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:PAGE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 W MORRIS ST
Mailing Address - Street 2:STE 102
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1059
Mailing Address - Country:US
Mailing Address - Phone:607-621-6157
Mailing Address - Fax:
Practice Address - Street 1:355 W MORRIS ST
Practice Address - Street 2:STE 102
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1059
Practice Address - Country:US
Practice Address - Phone:607-622-5383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2018-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0247801225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA1257Medicare PIN