Provider Demographics
NPI:1841012259
Name:STREET PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:STREET PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:STREET
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-591-6142
Mailing Address - Street 1:268 CHAMPLIN RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:NY
Mailing Address - Zip Code:13073-6221
Mailing Address - Country:US
Mailing Address - Phone:607-591-6142
Mailing Address - Fax:
Practice Address - Street 1:268 CHAMPLIN RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:NY
Practice Address - Zip Code:13073-6221
Practice Address - Country:US
Practice Address - Phone:607-591-6142
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty