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General NPI Number Information
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NPI Number | 1770079550
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Entity Type | Organization
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Legal Business Name | SUAREZ SPORT & ORTHOPEDIC PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 07/05/2018
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Last Update Date | 07/05/2018
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Provider Practice Location Address
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Address Line | 201 BERYL WAY
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City | WATERVLIET
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State | NY
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Zip | 12189-2970
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Country | US
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Telephone | 914-489-2319
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Fax |
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Provider Business Mailing Address
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Address Line | 201 BERYL WAY
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City | WATERVLIET
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State | NY
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Zip | 12189-2970
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Country | US
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Telephone | 914-489-2319
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK S SUAREZ
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Credential | PT, DPT, OCS, SCS
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Telephone | 518-348-9613
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 042738
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 042738
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License Number State | NY
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