Healthcare Provider Details

I. General information

NPI: 1285998179
Provider Name (Legal Business Name): JUVENTAS PHYSICAL OCCUPATIONAL & SPEECH THERAPY SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 E MARKET ST STE 201
CORNING NY
14830-2708
US

IV. Provider business mailing address

65 E MARKET ST STE 201
CORNING NY
14830-2708
US

V. Phone/Fax

Practice location:
  • Phone: 607-377-7482
  • Fax:
Mailing address:
  • Phone: 607-377-7482
  • Fax: 607-962-6986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number019336-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number012869-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number020655-1
License Number StateNY

VIII. Authorized Official

Name: DR. CARRIE RICHARDS
Title or Position: PHYSICAL THERAPIST/MANAGING PARTNER
Credential: PT, DPT, MSPT
Phone: 607-377-7482