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General NPI Number Information
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NPI Number | 1891989661
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Entity Type | Organization
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Legal Business Name | CREEKSIDE PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 14318 ROUTE 62
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City | COLLINS
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State | NY
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Zip | 14034-9788
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Country | US
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Telephone | 716-532-8129
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Fax | 716-532-9201
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Provider Business Mailing Address
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Address Line | 14318 ROUTE 62
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City | COLLINS
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State | NY
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Zip | 14034-9788
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Country | US
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Telephone | 716-532-8129
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Fax | 716-532-9201
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ELLEN BETH WILSON
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Credential | P.T.
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Telephone | 716-532-8129
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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 | 008212
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License Number State | NY
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