Healthcare Provider Details

I. General information

NPI: 1528280633
Provider Name (Legal Business Name): THERAPY SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 TIMMERMAN AVE
ST JOHNSVILLE NY
13452-1017
US

IV. Provider business mailing address

7 TIMMERMAN AVE
ST JOHNSVILLE NY
13452-1017
US

V. Phone/Fax

Practice location:
  • Phone: 518-568-5037
  • Fax: 518-568-5477
Mailing address:
  • Phone: 518-568-5037
  • Fax: 518-568-5477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number19751-1
License Number StateNY

VIII. Authorized Official

Name: MRS. ANDREA MUHLEBECK
Title or Position: MEMBER
Credential:
Phone: 518-568-5037