Healthcare Provider Details

I. General information

NPI: 1972228864
Provider Name (Legal Business Name): CAYUGA PHYSICAL THERAPY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2022
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

953 DANBY RD
ITHACA NY
14850-7000
US

IV. Provider business mailing address

101 DATES DR
ITHACA NY
14850-1342
US

V. Phone/Fax

Practice location:
  • Phone: 607-274-3177
  • Fax:
Mailing address:
  • Phone:
  • 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: BRIAN LEE
Title or Position: OWNER
Credential: PT
Phone: 607-274-4011