Provider Demographics
NPI:1356195572
Name:COMPREHENSIVE PERFORMANCE PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:COMPREHENSIVE PERFORMANCE PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:CRANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:DPT, PT
Authorized Official - Phone:315-877-8992
Mailing Address - Street 1:280 COUNTY ROAD 44
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815-2209
Mailing Address - Country:US
Mailing Address - Phone:607-334-6273
Mailing Address - Fax:607-334-8770
Practice Address - Street 1:280 COUNTY ROAD 44
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:NY
Practice Address - Zip Code:13815-2209
Practice Address - Country:US
Practice Address - Phone:607-334-6273
Practice Address - Fax:607-334-8770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy