Provider Demographics
NPI:1457598013
Name:BERTOLOZZI PHYSICAL THERAPY SERVICES PC
Entity Type:Organization
Organization Name:BERTOLOZZI PHYSICAL THERAPY SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERTOLOZZI
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICAL THERAPIST
Authorized Official - Phone:845-635-4555
Mailing Address - Street 1:PO BOX 1198
Mailing Address - Street 2:
Mailing Address - City:PLEASANT VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:12569-7868
Mailing Address - Country:US
Mailing Address - Phone:845-635-4555
Mailing Address - Fax:845-635-9555
Practice Address - Street 1:1335 ROUTE 44 STE 3B
Practice Address - Street 2:
Practice Address - City:PLEASANT VALLEY
Practice Address - State:NY
Practice Address - Zip Code:12569-7868
Practice Address - Country:US
Practice Address - Phone:845-635-4555
Practice Address - Fax:845-635-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025213305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service