Provider Demographics
NPI:1720328099
Name:ZUPPA PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ZUPPA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUPPA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:518-878-1805
Mailing Address - Street 1:105 LAKE HILL RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BURNT HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12027-9507
Mailing Address - Country:US
Mailing Address - Phone:518-878-1805
Mailing Address - Fax:888-370-2441
Practice Address - Street 1:105 LAKE HILL RD
Practice Address - Street 2:SUITE 4
Practice Address - City:BURNT HILLS
Practice Address - State:NY
Practice Address - Zip Code:12027-9507
Practice Address - Country:US
Practice Address - Phone:518-878-1805
Practice Address - Fax:888-370-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-25
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02692753Medicaid
NY02692753Medicaid