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General NPI Number Information
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NPI Number | 1285180463
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Entity Type | Organization
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Legal Business Name | PENN YAN PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 08/29/2016
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Last Update Date | 08/29/2016
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Provider Practice Location Address
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Address Line | 207 1/2 LAKE ST
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City | PENN YAN
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State | NY
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Zip | 14527-1802
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Country | US
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Telephone | 585-582-0007
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Fax | 888-822-9237
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Provider Business Mailing Address
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Address Line | PO BOX 699
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City | MENDON
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State | NY
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Zip | 14506-0699
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Country | US
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Telephone | 585-582-0007
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Fax | 888-822-9237
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN SHUMAN
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Credential | PT
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Telephone | 585-315-2339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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