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General NPI Number Information
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NPI Number | 1528796059
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Entity Type | Organization
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Legal Business Name | G2 PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 08/11/2022
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 10 ELM ST
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City | CORNWALL
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State | NY
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Zip | 12518-1485
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Country | US
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Telephone | 646-479-9214
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 467
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City | CORNWALL
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State | NY
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Zip | 12518-0467
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Country | US
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Telephone | 646-479-9214
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST/CO-OWNER
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Name | JEFFERSON GARROVILLAS
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Credential | PT, DPT
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Telephone | 646-479-9214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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