Provider Demographics
NPI:1669576054
Name:CATSKILL MOUNTAIN PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:CATSKILL MOUNTAIN PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-688-7064
Mailing Address - Street 1:318FOXHOLLOWRD
Mailing Address - Street 2:
Mailing Address - City:SHANDAKEN
Mailing Address - State:NY
Mailing Address - Zip Code:12480-0064
Mailing Address - Country:US
Mailing Address - Phone:845-688-7064
Mailing Address - Fax:845-688-2811
Practice Address - Street 1:319 MAVERICK RD
Practice Address - Street 2:
Practice Address - City:GLENFDORD
Practice Address - State:NY
Practice Address - Zip Code:12498
Practice Address - Country:US
Practice Address - Phone:845-688-7064
Practice Address - Fax:845-688-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014531-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY603426OtherMVP
NYQ16R71OtherEMPIRE BLUE CROSS BS
NY10096311OtherCDPHP
NY1770507469OtherINDIVIDUAL NPI
NY89756OtherGHI HMO
NY89756OtherGHI HMO
NYQL1811Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
NYQ5WBE1Medicare ID - Type Unspecified