Healthcare Provider Details

I. General information

NPI: 1477782589
Provider Name (Legal Business Name): CHITTENANGO PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2009
Last Update Date: 08/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1398 ROUTE 5 W
CHITTENANGO NY
13037
US

IV. Provider business mailing address

1398 ROUTE 5 W
CHITTENANGO NY
13037
US

V. Phone/Fax

Practice location:
  • Phone: 315-510-3372
  • Fax: 315-510-3688
Mailing address:
  • Phone: 315-510-3372
  • Fax: 315-510-3688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: JAMIE BENOIT
Title or Position: MANAGER
Credential:
Phone: 315-510-3372