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General NPI Number Information
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NPI Number | 1972627230
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Entity Type | Individual
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Provider Name | PAUL WASSERMAN P.T.
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 120 KISCO AVE
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City | MOUNT KISCO
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State | NY
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Zip | 10549-1415
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Country | US
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Telephone | 914-242-8760
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Fax | 914-242-8762
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Provider Business Mailing Address
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Address Line | 88 LAKEVIEW DR
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City | BREWSTER
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State | NY
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Zip | 10509-2803
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Country | US
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Telephone | 845-278-2357
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 006951-1
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License Number State | NY
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