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NPI Code Detail

MEDICARE: MRS. KERI JO ROCKWOOD PT

MEDICARE: MRS. KERI JO ROCKWOOD PT
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
1225100000XPhysical Therapist021452-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
111226391OTHERNYCAQH PROVIDER ID

General Provider Information

NPI Number : 1972639979
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KERI JO ROCKWOOD PT
Provider Business Mailing Address
First Line : 7310 LARAWAY RD
Second Line :
City : CAYUGA
State : NY
Zip : 13034-3113
Country : US
Telephone Number : 315-253-7178
Fax Number : 315-364-8016
Provider Business Practice Location Address
First Line : 8842 STATE ROUTE 90 N
Second Line : MANDEL THERAPY GROUP
City : KING FERRY
State : NY
Zip : 13081-8717
Country : US
Telephone Number : 315-364-7570
Fax Number : 315-364-8016
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/26/2007
Last Update Date : 07/08/2007

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