Healthcare Provider Details

I. General information

NPI: 1083834758
Provider Name (Legal Business Name): PHYSICAL THERAPY PROFESSIONALS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 THOMAS DR
LAKEVILLE NY
14480-9730
US

IV. Provider business mailing address

3506 THOMAS DR
LAKEVILLE NY
14480-9730
US

V. Phone/Fax

Practice location:
  • Phone: 585-346-0060
  • Fax: 585-346-0108
Mailing address:
  • Phone: 585-346-0060
  • Fax: 585-346-0108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012242
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number017728
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number023289
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number018661
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number009223
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number026428
License Number StateNY
# 7
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number012202
License Number StateNY

VIII. Authorized Official

Name: MRS. SUSAN FARRELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 585-346-0060