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General NPI Number Information
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NPI Number | 1861999351
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Entity Type | Organization
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Legal Business Name | SILVERMAPLE PHYSICAL THERAPY PLLC
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Dates
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Enumeration Date | 04/10/2018
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Last Update Date | 04/10/2018
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Provider Practice Location Address
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Address Line | 11 CENTURY HILL DR STE 104
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City | LATHAM
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State | NY
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Zip | 12110-2151
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Country | US
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Telephone | 617-538-4862
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Fax |
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Provider Business Mailing Address
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Address Line | 7 DAWSON LN
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City | CLIFTON PARK
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State | NY
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Zip | 12065-1850
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | KETAKI NAGARKAR
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Credential |
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Telephone | 617-538-4862
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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 | 027090
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License Number State | NY
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