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General NPI Number Information
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NPI Number | 1831376623
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Entity Type | Organization
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Legal Business Name | BRIGHTON PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 01/24/2008
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Last Update Date | 01/24/2008
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Provider Practice Location Address
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Address Line | 181 INTREPID LN
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City | SYRACUSE
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State | NY
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Zip | 13205-2548
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Country | US
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Telephone | 315-558-4907
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Fax |
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Provider Business Mailing Address
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Address Line | 181 INTREPID LN
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City | SYRACUSE
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State | NY
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Zip | 13205-2548
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Country | US
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Telephone | 315-558-4907
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Fax |
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | MR. KEVIN L GRETSKY
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Credential | PT
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Telephone | 315-558-4907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 0121881
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License Number State | NY
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