Healthcare Provider Details

I. General information

NPI: 1922071257
Provider Name (Legal Business Name): PRIMARY PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

792 N MAIN ST SUITE 100C
NORTH SYRACUSE NY
13212-1644
US

IV. Provider business mailing address

792 N MAIN ST SUITE 100C
NORTH SYRACUSE NY
13212-1644
US

V. Phone/Fax

Practice location:
  • Phone: 315-458-2552
  • Fax: 315-458-2575
Mailing address:
  • Phone: 315-458-2552
  • Fax: 315-458-2575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE L STEARNS
Title or Position: VP ADMIN
Credential:
Phone: 315-458-2552