Healthcare Provider Details

I. General information

NPI: 1417959461
Provider Name (Legal Business Name): MICHAEL PATRICK HUSON PT, DPT, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 02/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 W WASHINGTON ST
GENEVA NY
14456-2119
US

IV. Provider business mailing address

675 W WASHINGTON ST
GENEVA NY
14456-2119
US

V. Phone/Fax

Practice location:
  • Phone: 315-781-1144
  • Fax:
Mailing address:
  • Phone: 315-781-1144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number023660-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: