MEDICARE: FAMILY PHYSICAL THERAPY PLLC

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	021515	NY

General Provider Information

NPI Number	:	1750463188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	327 MILES AVENUE
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13210
Country	:	US
Telephone Number	:	315-882-1060
Fax Number	:	315-295-2208

Provider Business Practice Location Address
First Line	:	1106 EAST GENESEE STREET
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13210
Country	:	US
Telephone Number	:	315-882-1060
Fax Number	:	315-295-2208

Authorized Official
Title or Position	:	OWNER PHYSICAL THERAPIST
Name	:	PATRICK WILLIAM FORGET
Credential	:	PT DPT
Telephone Number	:	315-882-1060

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	08/22/2020

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