MEDICARE: MARIA THANNHAUSER DPT

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	225100000X	Physical Therapist	045468	NY

General Provider Information

NPI Number	:	1679183248
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA THANNHAUSER DPT

Provider Business Mailing Address
First Line	:	1398 STATE ROUTE 5
Second Line	:
City	:	CHITTENANGO
State	:	NY
Zip	:	13037-8763
Country	:	US
Telephone Number	:	315-510-3372
Fax Number	:	315-510-3688

Provider Business Practice Location Address
First Line	:	1398 STATE ROUTE 5
Second Line	:
City	:	CHITTENANGO
State	:	NY
Zip	:	13037-8763
Country	:	US
Telephone Number	:	315-510-3372
Fax Number	:	315-510-3688

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2020
Last Update Date	:	08/07/2020

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