Healthcare Provider Details

I. General information

NPI: 1972964732
Provider Name (Legal Business Name): DIANE VORE PHYSICAL THERAPIST A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 RIVER RD
MARCY NY
13403-2074
US

IV. Provider business mailing address

9501 RIVER RD
MARCY NY
13403
US

V. Phone/Fax

Practice location:
  • Phone: 315-724-0683
  • Fax: 315-797-7527
Mailing address:
  • Phone: 315-724-0683
  • Fax: 315-797-7527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberOOO533-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: