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General NPI Number Information
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NPI Number | 1518245224
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Entity Type | Organization
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Legal Business Name | ASCENT WELLNESS PT OT LMT PLLC
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 10/29/2013
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Provider Practice Location Address
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Address Line | 2885 ESSEX RD
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City | ESSEX
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State | NY
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Zip | 12936-2317
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Country | US
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Telephone | 518-963-7509
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 23
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City | WILLSBORO
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State | NY
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Zip | 12996-0023
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Country | US
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Telephone | 518-534-3903
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Fax |
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Authorized Official
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Title or Position | PT / OWNER
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Name | BRIAN TRZASKOS
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Credential |
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Telephone | 518-534-3903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 010698
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 018365
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 018647
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 013882
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License Number State | NY
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