Healthcare Provider Details

I. General information

NPI: 1265431894
Provider Name (Legal Business Name): ADAM P RUFA PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 04/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5496 E TAFT RD SUITE 2
NORTH SYRACUSE NY
13212-3784
US

IV. Provider business mailing address

5496 E TAFT RD SUITE 2
NORTH SYRACUSE NY
13212-3784
US

V. Phone/Fax

Practice location:
  • Phone: 315-451-6541
  • Fax: 315-451-7059
Mailing address:
  • Phone: 315-451-6541
  • Fax: 315-451-7059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number024346-2
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: