Provider Demographics
NPI:1700882289
Name:MARTIN PAUL AUDYCKI
Entity Type:Organization
Organization Name:MARTIN PAUL AUDYCKI
Other - Org Name:ROCHESTER SPORTS & PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:AUDYCKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:585-227-2580
Mailing Address - Street 1:1564 LONG POND RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4119
Mailing Address - Country:US
Mailing Address - Phone:585-227-2580
Mailing Address - Fax:585-227-3077
Practice Address - Street 1:1564 LONG POND RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4119
Practice Address - Country:US
Practice Address - Phone:585-334-8090
Practice Address - Fax:585-334-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA1449/DD3760Medicare UPIN