Healthcare Provider Details

I. General information

NPI: 1851921597
Provider Name (Legal Business Name): NEURO FIT PT AND SLP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2020
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 CRAWFORD AVE
SYRACUSE NY
13224-1709
US

IV. Provider business mailing address

103 CRAWFORD AVE
SYRACUSE NY
13224-1709
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational 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: PHYSICAL THERAPIST
Credential: PT
Phone: 716-868-1114