MEDICARE: UPSTATE PHYSICAL THERAPY P.C.

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	05220-1	NY

General Provider Information

NPI Number	:	1730115015
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UPSTATE PHYSICAL THERAPY P.C.

Provider Business Mailing Address
First Line	:	141 SULLYS TRL
Second Line	:	SUITE 9
City	:	PITTSFORD
State	:	NY
Zip	:	14534-4563
Country	:	US
Telephone Number	:	585-387-0430
Fax Number	:	585-387-0431

Provider Business Practice Location Address
First Line	:	141 SULLYS TRL
Second Line	:	SUITE 9
City	:	PITTSFORD
State	:	NY
Zip	:	14534-4563
Country	:	US
Telephone Number	:	585-387-0430
Fax Number	:	585-387-0431

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CATHLEEN C. LEONARD.
Credential	:	P.T.
Telephone Number	:	585-387-0430

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	08/22/2020

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Directions to “UPSTATE PHYSICAL THERAPY P.C. ” Practice Location

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