Healthcare Provider Details

I. General information

NPI: 1336370683
Provider Name (Legal Business Name): RAYMON STEPHEN WEBSTER IV D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 03/23/2020
Certification Date: 03/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21A RAILROAD AVE UNIT B
ALBANY NY
12205-5931
US

IV. Provider business mailing address

21A RAILROAD AVE UNIT B
ALBANY NY
12205-5931
US

V. Phone/Fax

Practice location:
  • Phone: 518-650-6962
  • Fax:
Mailing address:
  • Phone: 518-650-6962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number037709-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: