Healthcare Provider Details

I. General information

NPI: 1770838849
Provider Name (Legal Business Name): COURTNEY PILC PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 12/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 MEDTECH DRIVE
BATAVIA NY
14020
US

IV. Provider business mailing address

590 FISHERS STATION DR SUITE 130
VICTOR NY
14564-9744
US

V. Phone/Fax

Practice location:
  • Phone: 585-455-6191
  • Fax:
Mailing address:
  • Phone: 585-924-7207
  • Fax: 585-924-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number035080
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number035080
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: