Provider Demographics
NPI:1396063491
Name:CLIFTON PARK PHYSICAL THERAPY
Entity type:Organization
Organization Name:CLIFTON PARK PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHEL
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-383-2610
Mailing Address - Street 1:4 EMMA LN
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-3763
Mailing Address - Country:US
Mailing Address - Phone:518-383-2610
Mailing Address - Fax:518-383-8188
Practice Address - Street 1:4 EMMA LN
Practice Address - Street 2:SUITE 401
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3763
Practice Address - Country:US
Practice Address - Phone:518-383-2610
Practice Address - Fax:518-383-8188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024224-12081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty