MEDICARE: ACHIEVE 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	010239	NY

General Provider Information

NPI Number	:	1790778983
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACHIEVE PHYSICAL THERAPY, PC

Provider Business Mailing Address
First Line	:	1001 W FAYETTE ST
Second Line	:	SUITE 400
City	:	SYRACUSE
State	:	NY
Zip	:	13204-2859
Country	:	US
Telephone Number	:	315-472-1488
Fax Number	:	315-476-1792

Provider Business Practice Location Address
First Line	:	4700 ONONDAGA BLVD
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13219-3316
Country	:	US
Telephone Number	:	315-475-7121
Fax Number	:	315-475-7144

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MR. MARTIN CANAVAN
Credential	:	PT
Telephone Number	:	315-475-7121

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	05/06/2008

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