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NPI Code Detail

MEDICARE: RILEY FITZSIMONS PT, DPT

MEDICARE: RILEY FITZSIMONS PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist046692NY

General Provider Information

NPI Number : 1174103923
Entity Type Code : Individual
Provider Name (Legal Business Name) : RILEY FITZSIMONS PT, DPT
Provider Business Mailing Address
First Line : 2250 N TRIPHAMMER RD APT M3E
Second Line :
City : ITHACA
State : NY
Zip : 14850-1512
Country : US
Telephone Number : 973-534-5657
Fax Number :
Provider Business Practice Location Address
First Line : 4600 SOUTHWOOD HEIGHTS DR
Second Line :
City : JAMESVILLE
State : NY
Zip : 13078-9595
Country : US
Telephone Number : 315-469-1300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2021
Last Update Date : 04/14/2021

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