Healthcare Provider Details

I. General information

NPI: 1073535175
Provider Name (Legal Business Name): PREMIER PHYSICAL THERAPY AND WELLNESS OF KATONAH, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 WHITE PLAINS ROAD LL
EASTCHESTER NY
10709
US

IV. Provider business mailing address

1536 3RD AVE 5TH FL.
NEW YORK NY
10028-2167
US

V. Phone/Fax

Practice location:
  • Phone: 914-771-6200
  • Fax: 914-771-6202
Mailing address:
  • Phone: 212-861-2630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARYANNE NOLAN
Title or Position: DIRECTOR
Credential:
Phone: 212-861-2630