Healthcare Provider Details

I. General information

NPI: 1457524944
Provider Name (Legal Business Name): CHURCHVILLE PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2008
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 WASHINGTON ST SUITE A100
CHURCHVILLE NY
14428-9603
US

IV. Provider business mailing address

7 WASHINGTON ST SUITE A100
CHURCHVILLE NY
14428-9603
US

V. Phone/Fax

Practice location:
  • Phone: 585-293-9160
  • Fax: 585-293-9175
Mailing address:
  • Phone: 585-293-9160
  • Fax: 585-293-9175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number024288-1
License Number StateNY

VIII. Authorized Official

Name: ARTHUR ROBERT MINERY
Title or Position: PRESIDENT
Credential: MS PT
Phone: 585-293-9160