=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164542486
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAMILLUS PHYSICAL THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5700 W GENESEE ST SUITE 2S
-----------------------------------------------------
City | CAMILLUS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13031-3200
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-452-5580
-----------------------------------------------------
Fax | 315-452-5303
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5700 WEST GENESEE STREET SUITE 2S
-----------------------------------------------------
City | CAMILLUS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-452-5580
-----------------------------------------------------
Fax | 315-452-5303
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MRS. KAREN DEMERS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 315-452-5580
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------