MEDICARE: KIMBERLY T BASCOM PTA

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	225200000X	Physical Therapy Assistant	005165	NY

General Provider Information

NPI Number	:	1821305194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY T BASCOM PTA

Provider Business Mailing Address
First Line	:	14 FACTORY ST
Second Line	:
City	:	GRANVILLE
State	:	NY
Zip	:	12832-1312
Country	:	US
Telephone Number	:	518-361-9753
Fax Number	:

Provider Business Practice Location Address
First Line	:	429 AVIATION RD
Second Line	:
City	:	QUEENSBURY
State	:	NY
Zip	:	12804-2914
Country	:	US
Telephone Number	:	518-824-1600
Fax Number	:

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

Provider Enumeration Date	:	09/08/2010
Last Update Date	:	09/08/2010

Similar Medicare Providers

1366380800 — JENNIFER KENNEDY
Practice Location Address:

431 AVIATION RD
QUEENSBURY, NY
12804-2914

Practice Phone: 518-824-1600
Practice Fax:

1578411328 — KAITLYN BEECHER
Practice Location Address:

425 AVIATION RD
QUEENSBURY, NY
12804-2914

Practice Phone: 518-824-2703
Practice Fax: 518-691-9430

1083868236 — ALISSA MARIE IANTOSCA CCC-SLP
Practice Location Address:

429 AVIATION RD
QUEENSBURY, NY
12804-2914

Practice Phone: 518-824-2600
Practice Fax:

1851609648 — MRS. THERESA M MORAN OTR/L
Practice Location Address:

429 AVIATION RD
QUEENSBURY, NY
12804-2914

Practice Phone: 518-824-2600
Practice Fax:

1912216839 — JACQUELINE MULCAHY RN
Practice Location Address:

425 AVIATION RD
QUEENSBURY, NY
12804-2914

Practice Phone: 518-824-2603
Practice Fax: 518-824-2680

1609185115 — MRS. TERRY LYNN WIART RN
Practice Location Address:

429 AVIATION RD
QUEENSBURY, NY
12804-2914

Practice Phone: 518-824-5699
Practice Fax:

Directions to “ KIMBERLY T BASCOM PTA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.