Healthcare Provider Details

I. General information

NPI: 1164478285
Provider Name (Legal Business Name): PLAZA SPORTS MEDICINE & REHABILITATION PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE WHIPPLE LANE
ROCHESTER NY
14622
US

IV. Provider business mailing address

ONE WHIPPLE LANE
ROCHESTER NY
14622
US

V. Phone/Fax

Practice location:
  • Phone: 585-338-3070
  • Fax: 585-336-5014
Mailing address:
  • Phone: 585-338-3070
  • Fax: 585-336-5014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JUDITH R OLSON
Title or Position: DIRECTOR
Credential:
Phone: 585-338-3070