MEDICARE: AUSTIN STOCKERT DPT

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	052901	NY

General Provider Information

NPI Number	:	1881410611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUSTIN STOCKERT DPT

Provider Business Mailing Address
First Line	:	PO BOX 613
Second Line	:
City	:	GREENE
State	:	NY
Zip	:	13778-0613
Country	:	US
Telephone Number	:	607-656-4464
Fax Number	:	607-656-4593

Provider Business Practice Location Address
First Line	:	7 S CANAL ST STE 101
Second Line	:
City	:	GREENE
State	:	NY
Zip	:	13778-1288
Country	:	US
Telephone Number	:	607-656-4464
Fax Number	:	607-656-4593

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/26/2024
Last Update Date	:	11/26/2024

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Directions to “ AUSTIN STOCKERT DPT” Practice Location

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