Healthcare Provider Details

I. General information

NPI: 1255952099
Provider Name (Legal Business Name): NUNDA PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S WEST ST
NUNDA NY
14517-9685
US

IV. Provider business mailing address

25 S WEST ST PO BOX 614
NUNDA NY
14517-9685
US

V. Phone/Fax

Practice location:
  • Phone: 585-468-2020
  • Fax: 585-468-5001
Mailing address:
  • Phone: 585-468-2020
  • Fax: 585-468-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. ALICIA ANN EBERSOLE
Title or Position: PT/OWNER/AUTHORIZED OFFICIAL
Credential: PT
Phone: 585-468-2020