Healthcare Provider Details

I. General information

NPI: 1063541332
Provider Name (Legal Business Name): SPORTS THERAPY ALBANY P.T, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 EXECUTIVE PARK DR
ALBANY NY
12203-3718
US

IV. Provider business mailing address

4 EXECUTIVE PARK DR
ALBANY NY
12203-3718
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-2449
  • Fax: 518-489-2991
Mailing address:
  • Phone: 518-489-2449
  • Fax: 518-489-2991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. THOMAS F. FASHOUER
Title or Position: DIRECTOR OF REHABILITATION
Credential: ATC
Phone: 518-489-2449