Provider Demographics
NPI:1700965407
Name:ORTHOPEDIC AND SPORTS THERAPY ASSOCIATES, LLP
Entity Type:Organization
Organization Name:ORTHOPEDIC AND SPORTS THERAPY ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:W
Authorized Official - Last Name:DALE
Authorized Official - Suffix:
Authorized Official - Credentials:ATC
Authorized Official - Phone:607-737-1393
Mailing Address - Street 1:303 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-2914
Mailing Address - Country:US
Mailing Address - Phone:607-737-1393
Mailing Address - Fax:607-737-0775
Practice Address - Street 1:303 W WATER ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-2914
Practice Address - Country:US
Practice Address - Phone:607-737-1393
Practice Address - Fax:607-737-0775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0274Medicare ID - Type UnspecifiedMEDICARE GROUP #