Healthcare Provider Details

I. General information

NPI: 1639474067
Provider Name (Legal Business Name): HAND REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2011
Last Update Date: 01/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4901 LAC DE VILLE BLVD STE 130
ROCHESTER NY
14618-5648
US

IV. Provider business mailing address

4901 LAC DE VILLE BLVD STE 130
ROCHESTER NY
14618-5648
US

V. Phone/Fax

Practice location:
  • Phone: 585-341-9050
  • Fax: 585-341-4252
Mailing address:
  • Phone: 585-341-9050
  • Fax: 585-341-4252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number14375-1
License Number StateNY

VIII. Authorized Official

Name: MRS. LAURA LYNN GLASER
Title or Position: PHYSICAL THERAPIST
Credential: MS,PT,CHT
Phone: 585-341-9050