Healthcare Provider Details

I. General information

NPI: 1295321339
Provider Name (Legal Business Name): BIG BEAR PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 01/15/2021
Certification Date: 01/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

62 BENTON HOLLOW RD
LIBERTY NY
12754-2401
US

IV. Provider business mailing address

62 BENTON HOLLOW RD
LIBERTY NY
12754-2401
US

V. Phone/Fax

Practice location:
  • Phone: 845-594-7588
  • Fax: 845-859-5215
Mailing address:
  • Phone: 845-594-7588
  • Fax: 845-859-5215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS ABPLANALP
Title or Position: OWNER
Credential: MPT, ATC
Phone: 845-594-7588