MEDICARE: SOUTHERN TIER PHYSICAL THERAPY OF BINGHAMTON 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

General Provider Information

NPI Number	:	1881759041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN TIER PHYSICAL THERAPY OF BINGHAMTON PC

Provider Business Mailing Address
First Line	:	17 CHARLES ST
Second Line	:
City	:	BINGHAMTON
State	:	NY
Zip	:	13905-2224
Country	:	US
Telephone Number	:	607-771-8181
Fax Number	:	607-772-2899

Provider Business Practice Location Address
First Line	:	17 CHARLES ST
Second Line	:
City	:	BINGHAMTON
State	:	NY
Zip	:	13905-2224
Country	:	US
Telephone Number	:	607-771-8181
Fax Number	:	607-772-2899

Authorized Official
Title or Position	:	PHYSICAL THERAPIST OWNER
Name	:	MATTHEW MYETTE
Credential	:
Telephone Number	:	607-771-8181

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	12/01/2015

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