Healthcare Provider Details

I. General information

NPI: 1568178218
Provider Name (Legal Business Name): INTEGRATED PHYSICAL THERAPY OF IRONDEQUOIT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

884 E RIDGE RD
ROCHESTER NY
14621-1718
US

IV. Provider business mailing address

16 MAIN ST
HILTON NY
14468-1211
US

V. Phone/Fax

Practice location:
  • Phone: 585-544-4077
  • Fax: 585-544-4070
Mailing address:
  • Phone: 585-391-0394
  • Fax: 585-392-8126

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: JOHN ZASTAWRNY
Title or Position: OWNER
Credential:
Phone: 585-719-6493