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General NPI Number Information
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NPI Number | 1114251881
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Entity Type | Organization
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Legal Business Name | FREEDOM THERAPY
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Dates
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Enumeration Date | 09/28/2009
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Last Update Date | 09/28/2009
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Provider Practice Location Address
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Address Line | 384 EAST AVE SUITE B
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City | ROCHESTER
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State | NY
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Zip | 14607-1909
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Country | US
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Telephone | 585-720-9608
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Fax | 585-720-5484
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Provider Business Mailing Address
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Address Line | 384 EAST AVE SUITE B
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City | ROCHESTER
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State | NY
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Zip | 14607-1909
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Country | US
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Telephone | 585-720-9608
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Fax | 585-720-5484
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JOSEPH BURGE
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Credential |
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Telephone | 585-720-9608
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 013518-1
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License Number State | NY
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