MEDICARE: JUVENTAS PHYSICAL OCCUPATIONAL & SPEECH THERAPY SERVICES PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	012869-1	NY
2	235Z00000X	Speech-Language Pathologist	020655-1	NY
3	225100000X	Physical Therapist	019336-1	NY

General Provider Information

NPI Number	:	1285998179
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JUVENTAS PHYSICAL OCCUPATIONAL & SPEECH THERAPY SERVICES PLLC

Provider Business Mailing Address
First Line	:	65 E MARKET ST STE 201
Second Line	:
City	:	CORNING
State	:	NY
Zip	:	14830-2708
Country	:	US
Telephone Number	:	607-377-7482
Fax Number	:	607-962-6986

Provider Business Practice Location Address
First Line	:	65 E MARKET ST STE 201
Second Line	:
City	:	CORNING
State	:	NY
Zip	:	14830-2708
Country	:	US
Telephone Number	:	607-377-7482
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/MANAGING PARTNER
Name	:	DR. CARRIE RICHARDS
Credential	:	PT, DPT, MSPT
Telephone Number	:	607-377-7482

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	05/19/2023

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