Healthcare Provider Details

I. General information

NPI: 1629105481
Provider Name (Legal Business Name): LATTIMORE OF GENESEO PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 04/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 VILLAGE PLZ
DANSVILLE NY
14437-9260
US

IV. Provider business mailing address

40 VILLAGE PLZ
DANSVILLE NY
14437-9260
US

V. Phone/Fax

Practice location:
  • Phone: 585-335-2456
  • Fax: 585-335-3494
Mailing address:
  • Phone: 585-335-2456
  • Fax: 585-335-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CAROL WHITBOURNE
Title or Position: BILLING MANAGER
Credential:
Phone: 585-851-9987