=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205149234
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACE THERAPY SERVICES, PT, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2010
-----------------------------------------------------
Last Update Date | 11/07/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5875 NIGHT WIND CIR
-----------------------------------------------------
City | JAMESVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13078-6475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-564-3687
-----------------------------------------------------
Fax | 315-359-6778
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5875 NIGHT WIND CIR
-----------------------------------------------------
City | JAMESVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13078-6475
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-564-3687
-----------------------------------------------------
Fax | 315-299-5319
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | ACE GONZALES SUMAGAYSAY
-----------------------------------------------------
Credential | PT, DPT
-----------------------------------------------------
Telephone | 718-564-3687
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 032206-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 027980-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------