=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558103929
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SYRACUSE PHYSICAL THERAPY PARTNERS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2024
-----------------------------------------------------
Last Update Date | 06/07/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 FALLON AVE
-----------------------------------------------------
City | SEAFORD
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19973-1577
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-536-1774
-----------------------------------------------------
Fax | 302-536-7096
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 659 S SALISBURY BLVD STE 1B
-----------------------------------------------------
City | SALISBURY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21801-5458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-831-3226
-----------------------------------------------------
Fax | 410-572-4041
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGIONAL MANAGER
-----------------------------------------------------
Name | JANICE M BALDWIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 410-831-3226
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225400000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------