Provider Demographics
NPI:1669558029
Name:ADIRONDACK PHYSICAL THERAPY & SPORTS REHAB, PC
Entity type:Organization
Organization Name:ADIRONDACK PHYSICAL THERAPY & SPORTS REHAB, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:STURGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-563-0267
Mailing Address - Street 1:39 COURT ST.
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901
Mailing Address - Country:US
Mailing Address - Phone:518-563-0267
Mailing Address - Fax:518-563-1633
Practice Address - Street 1:39 COURT ST.
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-563-0267
Practice Address - Fax:518-563-1633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA0736Medicare ID - Type Unspecified