Healthcare Provider Details

I. General information

NPI: 1902803786
Provider Name (Legal Business Name): STEPHEN WAYNE BASSIN P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STEPHEN W. BASSIN, P.T., P.C. 32 SHERMAN AVE
GLEN FALLS NY
12801
US

IV. Provider business mailing address

STEPHEN W. BASSIN, P.T., P.C. 32 SHERMAN AVE
GLEN FALLS NY
12801
US

V. Phone/Fax

Practice location:
  • Phone: 518-793-7136
  • Fax: 518-793-7142
Mailing address:
  • Phone: 518-793-7136
  • Fax: 518-793-7142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number005200
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: