Healthcare Provider Details

I. General information

NPI: 1255644043
Provider Name (Legal Business Name): PHOENIX PHYSICAL THERAPY & PTA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 07/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

447 FROGTOWN RD SUITE 301
HOGANSBURG NY
13655-3136
US

IV. Provider business mailing address

447 FROGTOWN RD SUITE 301
HOGANSBURG NY
13655-3136
US

V. Phone/Fax

Practice location:
  • Phone: 315-842-7966
  • Fax: 518-358-3174
Mailing address:
  • Phone: 315-842-7966
  • Fax: 518-358-3174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISA S FRANCIS
Title or Position: MANAGING MEMBER
Credential: PT
Phone: 315-842-7966