Healthcare Provider Details

I. General information

NPI: 1336641661
Provider Name (Legal Business Name): CANANDAIGUA PHYSICAL THERAPY P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 03/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3237 UNION ST
NORTH CHILI NY
14514-1129
US

IV. Provider business mailing address

PO BOX 699
MENDON NY
14506-0699
US

V. Phone/Fax

Practice location:
  • Phone: 585-594-1688
  • 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: CAROL WHITBOURNE
Title or Position: BILLING MANAGER
Credential:
Phone: 585-851-9987