Healthcare Provider Details

I. General information

NPI: 1780220756
Provider Name (Legal Business Name): CLARENCE JAMES ZIEGLER III MS PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2019
Last Update Date: 11/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 WINTON RD S
ROCHESTER NY
14618-3957
US

IV. Provider business mailing address

27 HELMSFORD WAY
PENFIELD NY
14526-1971
US

V. Phone/Fax

Practice location:
  • Phone: 585-784-6530
  • Fax: 585-341-2430
Mailing address:
  • Phone: 585-747-7662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number024298
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: