Healthcare Provider Details

I. General information

NPI: 1770670036
Provider Name (Legal Business Name): HOOSE, KNIGHT, AND ASSOCIATES PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 GARFIELD RD
POTSDAM NY
13676-3480
US

IV. Provider business mailing address

PO BOX 547 14 GARFIELD RD
POTSDAM NY
13676-0547
US

V. Phone/Fax

Practice location:
  • Phone: 315-265-7917
  • Fax: 315-265-5437
Mailing address:
  • Phone: 315-265-7917
  • Fax: 315-265-5437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number004089-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number013547-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number021008-1
License Number StateNY

VIII. Authorized Official

Name: MR. GARY S. HOOSE
Title or Position: CO-OWNER/PHYSICAL THERAPIST
Credential: PT
Phone: 315-265-7917