Healthcare Provider Details

I. General information

NPI: 1316071582
Provider Name (Legal Business Name): COXSACKIE PHYSICAL THERAPY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11831 STATE ROUTE 9W
W COXSACKIE NY
12192-3605
US

IV. Provider business mailing address

11831 STATE ROUTE 9W
W COXSACKIE NY
12192-3605
US

V. Phone/Fax

Practice location:
  • Phone: 518-731-1157
  • Fax: 518-731-1158
Mailing address:
  • Phone: 518-731-1157
  • Fax: 518-731-1158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number023390-1
License Number StateNY

VIII. Authorized Official

Name: MR. THOMAS JOSEPH CARROLL JR.
Title or Position: VP
Credential: MPT, CSCS
Phone: 518-731-1157