Healthcare Provider Details

I. General information

NPI: 1326375866
Provider Name (Legal Business Name): MENDON PHYSICAL THERAPY MANAGEMENT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2009
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 FINN RD SUITE C
HENRIETTA NY
14467-9393
US

IV. Provider business mailing address

60 FINN RD SUITE C
HENRIETTA NY
14467-9393
US

V. Phone/Fax

Practice location:
  • Phone: 585-444-0040
  • Fax: 585-444-0052
Mailing address:
  • Phone: 585-444-0040
  • Fax: 585-444-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number011899
License Number StateNY

VIII. Authorized Official

Name: MR. JOHN H SHUMAN
Title or Position: OWNER
Credential: MS, PT, ATC
Phone: 585-582-1330