Healthcare Provider Details

I. General information

NPI: 1861534281
Provider Name (Legal Business Name): PEDIATRIC PHYSICAL THERAPY SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3255 BRIGHTON HENRIETTA TOWN LINE RD SUITE 102
ROCHESTER NY
14623-2806
US

IV. Provider business mailing address

3255 BRIGHTON HENRIETTA TOWN LINE RD SUITE 102
ROCHESTER NY
14623-2806
US

V. Phone/Fax

Practice location:
  • Phone: 585-427-7610
  • Fax: 585-427-7410
Mailing address:
  • Phone: 585-427-7610
  • Fax: 585-427-7410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PIA L. STAMPE
Title or Position: OWNER
Credential: P.T.
Phone: 585-427-7610