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General NPI Number Information
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NPI Number | 1558431239
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Entity Type | Organization
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Legal Business Name | MULTISPORT PHYSICAL THERAPY & FITNESS PLLC
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 304 FIRST ST
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City | LIVERPOOL
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State | NY
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Zip | 13088
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Country | US
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Telephone | 315-451-2270
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Fax | 315-451-2271
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Provider Business Mailing Address
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Address Line | 304 FIRST ST MULTISPORT PHYSICAL THERAPY & FITNESS PLLC
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City | LIVERPOOL
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State | NY
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Zip | 13088
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Country | US
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Telephone | 315-451-2270
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Fax | 315-451-2271
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Authorized Official
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Title or Position | OWNER
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Name | CHARLES PROSSER
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Credential |
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Telephone | 315-451-2270
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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 | 01791
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License Number State | NY
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