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General NPI Number Information
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NPI Number | 1619106051
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Entity Type | Organization
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Legal Business Name | FREEDOM THERAPY , OT, PT & SLP, PLLC
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 07/16/2013
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Provider Practice Location Address
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Address Line | 2050 CLINTON AVE S
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City | ROCHESTER
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State | NY
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Zip | 14618-5727
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Country | US
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Telephone | 585-720-9608
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Fax | 585-720-5484
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Provider Business Mailing Address
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Address Line | 2050 CLINTON AVE S
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City | ROCHESTER
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State | NY
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Zip | 14618-5727
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Country | US
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Telephone | 585-720-9608
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Fax | 585-720-5484
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Authorized Official
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Title or Position | OWNER
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Name | MR. SAMUEL LOUIS BURGE II
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Credential |
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Telephone | 585-720-9608
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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 |
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License Number State |
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