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General NPI Number Information
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NPI Number | 1750709069
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Entity Type | Organization
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Legal Business Name | EASTWICK PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 04/03/2014
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Last Update Date | 04/03/2014
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Provider Practice Location Address
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Address Line | 4976 ROUTE 7
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City | HOOSICK
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State | NY
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Zip | 12089-0000
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Country | US
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Telephone | 518-915-4814
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Fax |
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Provider Business Mailing Address
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Address Line | 48 HOOSICK ST
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City | HOOSICK FALLS
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State | NY
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Zip | 12090-1713
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Country | US
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Telephone | 518-686-5010
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Fax |
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Authorized Official
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Title or Position | PT
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Name | MARY BRADLEY
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Credential | MSPT
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Telephone | 518-686-5010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 032058-1
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License Number State | NY
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