Healthcare Provider Details

I. General information

NPI: 1255641510
Provider Name (Legal Business Name): ACCESS THERAPY GROUP PT OT SLP AND PSYCHOLOGY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 11/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MOE RD
CLIFTON PARK NY
12065-3821
US

IV. Provider business mailing address

515 MOE RD
CLIFTON PARK NY
12065-3821
US

V. Phone/Fax

Practice location:
  • Phone: 518-280-4294
  • Fax: 518-280-4297
Mailing address:
  • Phone: 518-280-4294
  • Fax: 518-280-4297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number012145-1
License Number StateNY

VIII. Authorized Official

Name: MRS. KIMBERLY ANNE ROTHWELL
Title or Position: PROGRAM DIRECTOR
Credential: P.T.
Phone: 518-280-4294