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General NPI Number Information
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NPI Number | 1518046887
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Entity Type | Organization
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Legal Business Name | PERFORMANCE PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 165 HIGH ROCK AVE
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-2435
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Country | US
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Telephone | 518-832-1890
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 672
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-0672
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MSPT
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Name | MS. WENDY ANN MACIARIELLO
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Credential | MSPT
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Telephone | 518-832-1890
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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 | 023111-1
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License Number State | NY
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