MEDICARE: ZUPPA 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	027474	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720328099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ZUPPA PHYSICAL THERAPY PC

Provider Business Mailing Address
First Line	:	105 LAKE HILL RD
Second Line	:	SUITE 4
City	:	BURNT HILLS
State	:	NY
Zip	:	12027-9507
Country	:	US
Telephone Number	:	518-878-1805
Fax Number	:	888-370-2441

Provider Business Practice Location Address
First Line	:	105 LAKE HILL RD
Second Line	:	SUITE 4
City	:	BURNT HILLS
State	:	NY
Zip	:	12027-9507
Country	:	US
Telephone Number	:	518-878-1805
Fax Number	:	888-370-2441

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELO ZUPPA
Credential	:	PT
Telephone Number	:	518-878-1805

Provider Enumeration Date	:	02/25/2013
Last Update Date	:	02/25/2013

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