Provider Demographics
NPI:1740499821
Name:CANTON-POTSDAM HOSPITAL
Entity type:Organization
Organization Name:CANTON-POTSDAM HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:WHEAT
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-261-5490
Mailing Address - Street 1:470 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:EDWARDS
Mailing Address - State:NY
Mailing Address - Zip Code:13635-3188
Mailing Address - Country:US
Mailing Address - Phone:315-562-8493
Mailing Address - Fax:
Practice Address - Street 1:80 EAST MAIN ST.
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617
Practice Address - Country:US
Practice Address - Phone:315-261-5490
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015485-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy