Healthcare Provider Details

I. General information

NPI: 1841813805
Provider Name (Legal Business Name): ENGAGE PT OT AND SLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2020
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3175 E GENESEE ST STE 5
SYRACUSE NY
13224-1613
US

IV. Provider business mailing address

3175 E GENESEE ST STE 5
SYRACUSE NY
13224-1613
US

V. Phone/Fax

Practice location:
  • Phone: 716-868-1114
  • Fax: 833-262-8905
Mailing address:
  • Phone: 716-868-1114
  • Fax: 833-262-8905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH YATES HORTON
Title or Position: MANAGING MEMBER
Credential: PT
Phone: 716-868-1114