MEDICARE: HEENEY PHYSICAL THERAPY, PC

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	022761-1	NY
2	225100000X	Physical Therapist	021435-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1588666192	OTHER	NY	JOHN C BENDER, NPI
2	1043212681	OTHER	NY	JESSICA BENDER, NPI

General Provider Information

NPI Number	:	1720036254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEENEY PHYSICAL THERAPY, PC

Provider Business Mailing Address
First Line	:	2 ROSELL DR
Second Line	:	SUITE 100
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-1400
Country	:	US
Telephone Number	:	518-877-8900
Fax Number	:	518-877-8908

Provider Business Practice Location Address
First Line	:	2 ROSELL DR
Second Line	:	SUITE 100
City	:	BALLSTON LAKE
State	:	NY
Zip	:	12019-1400
Country	:	US
Telephone Number	:	518-877-8900
Fax Number	:	518-877-8908

Authorized Official
Title or Position	:	PHYSICAL THERAPIST/OWNER
Name	:	MR. JOHN C BENDER
Credential	:	P.T.
Telephone Number	:	518-877-8900

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	08/22/2020

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