Healthcare Provider Details

I. General information

NPI: 1841688470
Provider Name (Legal Business Name): FRESH START PHYSICAL THERAPY, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 01/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 NORTH AVE
SYRACUSE NY
13206-1644
US

IV. Provider business mailing address

907 NORTH AVE
SYRACUSE NY
13206-1644
US

V. Phone/Fax

Practice location:
  • Phone: 315-440-5953
  • Fax: 315-476-9694
Mailing address:
  • Phone: 315-440-5953
  • Fax: 315-476-9694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number021917
License Number StateNY

VIII. Authorized Official

Name: MRS. CHRISTINE MARIE DIORIO
Title or Position: MANAGER
Credential: PT
Phone: 315-440-5953