Healthcare Provider Details

I. General information

NPI: 1669426268
Provider Name (Legal Business Name): MOOCHLER PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 GENESEE ST
AUBURN NY
13021-3231
US

IV. Provider business mailing address

278 GENESEE ST
AUBURN NY
13021-3231
US

V. Phone/Fax

Practice location:
  • Phone: 315-282-0067
  • Fax: 315-282-0587
Mailing address:
  • Phone: 315-282-0067
  • Fax: 315-282-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number011136-1
License Number StateNY

VIII. Authorized Official

Name: MR. BARRY J MOOCHLER
Title or Position: PRESIDENT
Credential: PT
Phone: 315-282-0067