Provider Demographics
NPI:1770686917
Name:COUNTY PHYSICAL THERAPY
Entity type:Organization
Organization Name:COUNTY PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, CHT
Authorized Official - Phone:845-256-0820
Mailing Address - Street 1:40 SUNSET RIDGE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1036
Mailing Address - Country:US
Mailing Address - Phone:845-256-0820
Mailing Address - Fax:845-256-9028
Practice Address - Street 1:40 SUNSET RIDGE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1036
Practice Address - Country:US
Practice Address - Phone:845-256-0820
Practice Address - Fax:845-256-9028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012834174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ31921Medicare ID - Type Unspecified