Provider Demographics
NPI:1780894568
Name:PHYSICAL THERAPY ASSOCIATES OF SCHENECTADY, P.C.
Entity type:Organization
Organization Name:PHYSICAL THERAPY ASSOCIATES OF SCHENECTADY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COONEY
Authorized Official - Suffix:
Authorized Official - Credentials:MS,PT
Authorized Official - Phone:518-346-5168
Mailing Address - Street 1:1182 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE LLO2
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-1095
Mailing Address - Country:US
Mailing Address - Phone:518-220-9705
Mailing Address - Fax:518-220-9651
Practice Address - Street 1:1182 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE LLO2
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1026
Practice Address - Country:US
Practice Address - Phone:518-220-9705
Practice Address - Fax:518-220-9651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00761702Medicaid
NY00761702Medicaid