MEDICARE: NICHOLAS CHERNEGA PHYSICAL THERAPIST

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	038063-1	NY

General Provider Information

NPI Number	:	1730589227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS CHERNEGA PHYSICAL THERAPIST

Provider Business Mailing Address
First Line	:	800 VALLEY PLZ
Second Line	:	SUITE 9
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1046
Country	:	US
Telephone Number	:	607-729-2200
Fax Number	:	607-729-2202

Provider Business Practice Location Address
First Line	:	800 VALLEY PLZ
Second Line	:	SUITE 9
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-1046
Country	:	US
Telephone Number	:	607-729-2200
Fax Number	:	607-729-2202

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

Provider Enumeration Date	:	09/03/2014
Last Update Date	:	09/03/2014

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