MEDICARE: ONTARIO PHYSICAL THERAPY PC

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		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000914253002	OTHER	NY	HEALTH NOW
2	P010088761	OTHER	NY	BLUES PROVIDER #
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P010088761	OTHER	NY	POMCO
5	5225277	OTHER	NY	AENTA
6	103121FT	OTHER	NY	PREF CARE PROVIDER #

General Provider Information

NPI Number	:	1558320101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONTARIO PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	1272 RIDGE RD
Second Line	:
City	:	ONTARIO
State	:	NY
Zip	:	14519-9101
Country	:	US
Telephone Number	:	315-524-9735
Fax Number	:	315-524-4423

Provider Business Practice Location Address
First Line	:	1272 RIDGE RD
Second Line	:
City	:	ONTARIO
State	:	NY
Zip	:	14519-9101
Country	:	US
Telephone Number	:	315-524-9735
Fax Number	:	315-524-4423

Authorized Official
Title or Position	:	OWNER
Name	:	MR. PAUL TOPOREK
Credential	:	PT
Telephone Number	:	315-524-9735

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	06/14/2013

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