=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467088815
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLEX PHYSICAL THERAPY SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2020
-----------------------------------------------------
Last Update Date | 03/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 611 DIMMOCK HILL ROAD
-----------------------------------------------------
City | BINGHAMTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13905-1390
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-524-2060
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 709
-----------------------------------------------------
City | VESTAL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13851-0709
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-624-2060
-----------------------------------------------------
Fax | 607-348-1768
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JENNIFER BERGER
-----------------------------------------------------
Credential | PT
-----------------------------------------------------
Telephone | 607-624-2060
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------