=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952779233
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BROWNSTONE PHYSICAL THERAPY, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2015
-----------------------------------------------------
Last Update Date | 09/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1900 ROUTE 31 SUITE 12
-----------------------------------------------------
City | MACEDON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14502-8943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-986-4655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1900 ROUTE 31 SUITE 12
-----------------------------------------------------
City | MACEDON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14502-8943
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-986-4655
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING MANAGER
-----------------------------------------------------
Name | MS. ANNA M BESLEY
-----------------------------------------------------
Credential | CPC
-----------------------------------------------------
Telephone | 315-986-4655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2251S0007X
-----------------------------------------------------
Taxonomy Name | Sports Physical Therapist
-----------------------------------------------------
License Number | 039069
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------