Healthcare Provider Details

I. General information

NPI: 1679535058
Provider Name (Legal Business Name): JOSEPH SCALISE P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 04/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8112 ROUTE 12 SUITE 1
BARNEVELD NY
13304-2122
US

IV. Provider business mailing address

231 WALTON ST SUITE 200
SYRACUSE NY
13202-1230
US

V. Phone/Fax

Practice location:
  • Phone: 315-478-0380
  • Fax: 315-478-0388
Mailing address:
  • Phone: 315-478-0380
  • Fax: 315-478-0388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number025052
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: