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General NPI Number Information
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NPI Number | 1962788844
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Entity Type | Organization
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Legal Business Name | INDE PHYSICAL THERAPY, PLLC
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 733 GLENMARY DR
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City | OWEGO
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State | NY
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Zip | 13827-2644
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Country | US
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Telephone | 607-727-4895
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Fax |
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Provider Business Mailing Address
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Address Line | 733 GLENMARY DR
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City | OWEGO
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State | NY
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Zip | 13827-2644
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Country | US
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Telephone | 607-727-4895
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT J KOBZIEWICZ
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Credential | MSPT
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Telephone | 607-727-4895
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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 | 014151
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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 | PT007930L
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 014151
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License Number State | NY
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