Provider Demographics
NPI:1831259456
Name:RAYMOND PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:RAYMOND PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PT CEO
Authorized Official - Prefix:
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:RAYMOND
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-834-6496
Mailing Address - Street 1:2685 ERIE DR
Mailing Address - Street 2:
Mailing Address - City:WEEDSPORT
Mailing Address - State:NY
Mailing Address - Zip Code:13166-3204
Mailing Address - Country:US
Mailing Address - Phone:315-834-6496
Mailing Address - Fax:315-834-6499
Practice Address - Street 1:2685 ERIE DR
Practice Address - Street 2:
Practice Address - City:WEEDSPORT
Practice Address - State:NY
Practice Address - Zip Code:13166-3204
Practice Address - Country:US
Practice Address - Phone:315-834-6496
Practice Address - Fax:315-834-6499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2013-03-07
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
NY02140178Medicaid
NY02140178Medicaid