Healthcare Provider Details

I. General information

NPI: 1013968155
Provider Name (Legal Business Name): SPORTS PLUS PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8276 PARK ROAD
BATAVIA NY
14020
US

IV. Provider business mailing address

8276 PARK ROAD
BATAVIA NY
14020
US

V. Phone/Fax

Practice location:
  • Phone: 585-343-9496
  • Fax: 585-343-9497
Mailing address:
  • Phone: 585-343-9496
  • Fax: 585-343-9497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BETH D TRAVIS
Title or Position: VICE PRESIDENT
Credential: PT
Phone: 585-343-9496