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General NPI Number Information
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NPI Number | 1336536671
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Entity Type | Organization
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Legal Business Name | ROGER W. HERBOWY, PT
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 04/24/2015
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Provider Practice Location Address
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Address Line | 2516 GENESEE ST
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City | UTICA
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State | NY
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Zip | 13502-5814
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Country | US
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Telephone | 315-735-2728
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Fax | 315-735-7820
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Provider Business Mailing Address
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Address Line | 2516 GENESEE ST
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City | UTICA
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State | NY
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Zip | 13502-5814
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Country | US
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Telephone | 315-735-2728
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Fax | 315-735-7820
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Authorized Official
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Title or Position | OCCUPATIONAL THERAOIST
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Name | MRS. KRISTIN MARIE MCCULLY
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Credential | O.T.
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Telephone | 315-735-2728
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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 | 012286-1
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License Number State | NY
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