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NPI Code Detail

MEDICARE: CHARITY L PEMBROKE P.T.

MEDICARE: CHARITY L PEMBROKE P.T.
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 Therapist027148NY

General Provider Information

NPI Number : 1215929252
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARITY L PEMBROKE P.T.
Provider Business Mailing Address
First Line : 41 OCONNOR RD
Second Line :
City : FAIRPORT
State : NY
Zip : 14450-1327
Country : US
Telephone Number : 585-377-4660
Fax Number :
Provider Business Practice Location Address
First Line : 41 OCONNOR RD
Second Line :
City : FAIRPORT
State : NY
Zip : 14450-1327
Country : US
Telephone Number : 585-377-4660
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 04/15/2016

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Directions to “ CHARITY L PEMBROKE P.T.” Practice Location

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