Provider Demographics
NPI:1952462129
Name:GREATER ROCHESTER PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:GREATER ROCHESTER PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GENNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEGAETANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-671-1030
Mailing Address - Street 1:2000 EMPIRE BLVD
Mailing Address - Street 2:BLDG. #2
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-1957
Mailing Address - Country:US
Mailing Address - Phone:585-671-1030
Mailing Address - Fax:585-671-1991
Practice Address - Street 1:2000 EMPIRE BLVD
Practice Address - Street 2:BLDG. #2
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-1957
Practice Address - Country:US
Practice Address - Phone:585-671-1030
Practice Address - Fax:585-671-1991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
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
NYAA0509Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER