MEDICARE: ASCENT WELLNESS PT OT LMT 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	225X00000X	Occupational Therapist	010698	NY
2	225700000X	Massage Therapist	018365	NY
3	225700000X	Massage Therapist	018647	NY
4	225100000X	Physical Therapist	013882	NY

General Provider Information

NPI Number	:	1518245224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASCENT WELLNESS PT OT LMT PLLC

Provider Business Mailing Address
First Line	:	PO BOX 23
Second Line	:
City	:	WILLSBORO
State	:	NY
Zip	:	12996-0023
Country	:	US
Telephone Number	:	518-534-3903
Fax Number	:

Provider Business Practice Location Address
First Line	:	2885 ESSEX RD
Second Line	:
City	:	ESSEX
State	:	NY
Zip	:	12936-2317
Country	:	US
Telephone Number	:	518-963-7509
Fax Number	:

Authorized Official
Title or Position	:	PT / OWNER
Name	:	BRIAN TRZASKOS
Credential	:
Telephone Number	:	518-534-3903

Provider Enumeration Date	:	07/29/2011
Last Update Date	:	10/29/2013

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