MEDICARE: MARTIN PAUL AUDYCKI

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	010363	NY

General Provider Information

NPI Number	:	1700882289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARTIN PAUL AUDYCKI

Provider Business Mailing Address
First Line	:	1564 LONG POND RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4119
Country	:	US
Telephone Number	:	585-227-2580
Fax Number	:	585-227-3077

Provider Business Practice Location Address
First Line	:	1564 LONG POND RD
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-4119
Country	:	US
Telephone Number	:	585-334-8090
Fax Number	:	585-334-8104

Authorized Official
Title or Position	:	CO-OWNER/PHYSICAL THERAPIST
Name	:	MR. MARTIN PAUL AUDYCKI
Credential	:	PT
Telephone Number	:	585-227-2580

Provider Enumeration Date	:	06/21/2005
Last Update Date	:	08/22/2020

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