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General NPI Number Information
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NPI Number | 1235551219
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Entity Type | Organization
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Legal Business Name | PIVOT ACUPUNCTURE AND PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 01/10/2014
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Last Update Date | 01/10/2014
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Provider Practice Location Address
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Address Line | 64 CLOVERLAND DR
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City | ROCHESTER
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State | NY
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Zip | 14610-2709
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Country | US
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Telephone | 585-709-1482
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Fax | 585-348-2181
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Provider Business Mailing Address
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Address Line | 64 CLOVERLAND DR
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City | ROCHESTER
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State | NY
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Zip | 14610-2709
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Country | US
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Telephone | 585-709-1482
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Fax | 585-348-2181
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Authorized Official
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Title or Position | CO-OWNER
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Name | DEREK BARCLAY
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Credential | PT, LAC
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Telephone | 585-709-1482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 005091
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License Number State | NY
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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 | 030451
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 004900
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License Number State | NY
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