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General NPI Number Information
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NPI Number | 1225825193
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Entity Type | Organization
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Legal Business Name | SPROUT PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 04/23/2025
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | 2775 BUFFALO RD
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City | ROCHESTER
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State | NY
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Zip | 14624-1372
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Country | US
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Telephone | 585-290-1490
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Fax |
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Provider Business Mailing Address
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Address Line | 45 TELLIDORA TRL
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City | SPENCERPORT
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State | NY
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Zip | 14559-9404
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Country | US
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Telephone | 585-489-9775
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPY
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Name | MARIETTA JOANNE PHILLIPS
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Credential |
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Telephone | 585-290-1490
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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