Provider Demographics
NPI:1952779233
Name:BROWNSTONE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:BROWNSTONE PHYSICAL THERAPY, PC
Other - Org Name:BROWNSTONE VICTOR PHYSICAL THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BESLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:315-986-4655
Mailing Address - Street 1:1900 ROUTE 31
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-8943
Mailing Address - Country:US
Mailing Address - Phone:315-986-4655
Mailing Address - Fax:
Practice Address - Street 1:1900 ROUTE 31
Practice Address - Street 2:SUITE 12
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-8943
Practice Address - Country:US
Practice Address - Phone:315-986-4655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0390692251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY039069OtherLICENSE