MEDICARE: WALLKILL PHYSICAL THERAPY, PLLC

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
1	225100000X	Physical Therapist	009042	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1255379525	OTHER		NPI INDIVIDUAL PROVIDER #
2	11574902	OTHER		CAQH #

General Provider Information

NPI Number	:	1215965397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALLKILL PHYSICAL THERAPY, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 336
Second Line	:
City	:	WALLKILL
State	:	NY
Zip	:	12589-0336
Country	:	US
Telephone Number	:	845-895-9003
Fax Number	:	845-895-9006

Provider Business Practice Location Address
First Line	:	1500 STATE ROUTE 208
Second Line	:
City	:	WALLKILL
State	:	NY
Zip	:	12589-3712
Country	:	US
Telephone Number	:	845-895-9003
Fax Number	:	845-895-9006

Authorized Official
Title or Position	:	OWNER/MANAGER, PHYSICAL THERAPIST
Name	:	MRS. LORI A. SCHNEIDER
Credential	:	PT
Telephone Number	:	845-895-9003

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	04/20/2008

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