Healthcare Provider Details

I. General information

NPI: 1528122793
Provider Name (Legal Business Name): COUNTY PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 N CHESTNUT ST SUITE 1
NEW PALTZ NY
12561-1408
US

IV. Provider business mailing address

83 N. CHESTNUT ST SUITE 1
NEW PALTZ NY
12561
US

V. Phone/Fax

Practice location:
  • Phone: 845-256-0820
  • Fax: 845-256-9028
Mailing address:
  • Phone: 845-256-0820
  • Fax: 845-256-9028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number38096
License Number StateNY

VIII. Authorized Official

Name: MR. JAY HENRY
Title or Position: PHYSICAL THERAPIST
Credential:
Phone: 845-256-0820