Provider Demographics
NPI:1457524944
Name:CHURCHVILLE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:CHURCHVILLE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MINERY
Authorized Official - Suffix:
Authorized Official - Credentials:MS PT
Authorized Official - Phone:585-293-9160
Mailing Address - Street 1:7 WASHINGTON ST
Mailing Address - Street 2:SUITE A100
Mailing Address - City:CHURCHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14428-9603
Mailing Address - Country:US
Mailing Address - Phone:585-293-9160
Mailing Address - Fax:585-293-9175
Practice Address - Street 1:7 WASHINGTON ST
Practice Address - Street 2:SUITE A100
Practice Address - City:CHURCHVILLE
Practice Address - State:NY
Practice Address - Zip Code:14428-9603
Practice Address - Country:US
Practice Address - Phone:585-293-9160
Practice Address - Fax:585-293-9175
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024288-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy