=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386941870
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLEMING PHYSICAL THERAPY CONSULTANT PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2011
-----------------------------------------------------
Last Update Date | 10/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5010 STATE HIGHWAY 30
-----------------------------------------------------
City | AMSTERDAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12010-7532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-212-6291
-----------------------------------------------------
Fax | 518-212-2222
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5010 STATE HIGHWAY 30 STE 101
-----------------------------------------------------
City | AMSTERDAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12010-7532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-212-6291
-----------------------------------------------------
Fax | 518-212-2222
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROBERT B FLEMING JR.
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 518-857-7528
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 19221
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------