Healthcare Provider Details

I. General information

NPI: 1265936496
Provider Name (Legal Business Name): PURIFICATO PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 EXECUTIVE PARK DR
ALBANY NY
12203-3791
US

IV. Provider business mailing address

6 EXECUTIVE PARK DR
ALBANY NY
12203-3791
US

V. Phone/Fax

Practice location:
  • Phone: 518-512-3452
  • Fax: 518-599-0071
Mailing address:
  • Phone: 518-512-3452
  • Fax: 518-599-0071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number0219471
License Number StateNY

VIII. Authorized Official

Name: MRS. LAURA LYNN PURIFICATO
Title or Position: OWNER/PT
Credential: MSPT
Phone: 518-368-4119