Healthcare Provider Details

I. General information

NPI: 1376615724
Provider Name (Legal Business Name): PEAK PHYSICAL THERAPY SOUTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

84 EAST MAIN STREET
WASHINGTONVILLE NY
12586
US

IV. Provider business mailing address

84 EAST MAIN STREET
WASHINGTONVILLE NY
12586
US

V. Phone/Fax

Practice location:
  • Phone: 845-496-1616
  • Fax: 845-496-1674
Mailing address:
  • Phone: 845-496-1616
  • Fax: 845-496-1674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0133321
License Number StateNY

VIII. Authorized Official

Name: MR. CHARLES L WALKER
Title or Position: DIRECTOR PHYSICAL THERAPIST
Credential: MS PT
Phone: 845-496-1616