Provider Demographics
NPI:1700995685
Name:WINDSOR PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:WINDSOR PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:N
Authorized Official - Last Name:YAHNER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:607-655-2305
Mailing Address - Street 1:104 MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:13865-4141
Mailing Address - Country:US
Mailing Address - Phone:607-655-2305
Mailing Address - Fax:607-655-2306
Practice Address - Street 1:104 MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:13865-4141
Practice Address - Country:US
Practice Address - Phone:607-655-2305
Practice Address - Fax:607-655-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-06-12
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
NYBA1303Medicare PIN