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General NPI Number Information
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NPI Number | 1255393930
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Entity Type | Organization
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Legal Business Name | PREMIER PHYSICAL THERAPY OF THE FINGERLAKES, PLLC
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 06/11/2010
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Provider Practice Location Address
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Address Line | 229 PARRISH STREET SUITE 220
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City | CANANDAIGUA
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State | NY
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Zip | 14424
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Country | US
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Telephone | 585-394-3920
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Fax | 585-394-3997
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Provider Business Mailing Address
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Address Line | 229 PARRISH STREET SUITE 220
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City | CANANDAIGUA
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State | NY
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Zip | 14424
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Country | US
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Telephone | 585-394-3920
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Fax | 585-394-3997
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Authorized Official
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Title or Position | OWNER
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Name | MR. MITCHELL ROBERT CARLSON
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Credential | P.T.
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Telephone | 585-394-3920
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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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 | 014144-1
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License Number State | NY
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