Healthcare Provider Details

I. General information

NPI: 1255393930
Provider Name (Legal Business Name): PREMIER PHYSICAL THERAPY OF THE FINGERLAKES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 PARRISH STREET SUITE 220
CANANDAIGUA NY
14424
US

IV. Provider business mailing address

229 PARRISH STREET SUITE 220
CANANDAIGUA NY
14424
US

V. Phone/Fax

Practice location:
  • Phone: 585-394-3920
  • Fax: 585-394-3997
Mailing address:
  • Phone: 585-394-3920
  • Fax: 585-394-3997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number014144-1
License Number StateNY

VIII. Authorized Official

Name: MR. MITCHELL ROBERT CARLSON
Title or Position: OWNER
Credential: P.T.
Phone: 585-394-3920