Healthcare Provider Details

I. General information

NPI: 1275602567
Provider Name (Legal Business Name): JASON C. GRECO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 1/2 LAKE ST
PENN YAN NY
14527-1802
US

IV. Provider business mailing address

PO BOX 693
MENDON NY
14506-0693
US

V. Phone/Fax

Practice location:
  • Phone: 315-536-4051
  • Fax: 315-531-8577
Mailing address:
  • Phone: 585-582-1126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number026824-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: