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General NPI Number Information
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NPI Number | 1508876293
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Entity Type | Organization
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Legal Business Name | ADVANTAGE PHYSICAL THERAPY AT BROOKVIEW
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 568 COLUMBIA TPKE STE 2
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City | EAST GREENBUSH
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State | NY
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Zip | 12061
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Country | US
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Telephone | 518-477-6179
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Fax | 518-477-6209
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Provider Business Mailing Address
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Address Line | 568 COLUMBIA TPKE STE 2
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City | EAST GREENBUSH
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State | NY
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Zip | 12061
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Country | US
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Telephone | 518-477-6179
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Fax | 518-477-6209
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Authorized Official
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Title or Position | PRESIDENT PHYSICAL THERAPIST
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Name | MR. JOHN W FORNABAIO JR.
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Credential | PT CSCS
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Telephone | 518-477-6179
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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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