MEDICARE: WEST SIDE 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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1932288222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WEST SIDE PHYSICAL THERAPY, PC

Provider Business Mailing Address
First Line	:	315 BRIDGE ST
Second Line	:
City	:	SOLVAY
State	:	NY
Zip	:	13209
Country	:	US
Telephone Number	:	315-484-9447
Fax Number	:	315-484-4583

Provider Business Practice Location Address
First Line	:	315 BRIDGE ST
Second Line	:
City	:	SOLVAY
State	:	NY
Zip	:	13209
Country	:	US
Telephone Number	:	315-484-9447
Fax Number	:	315-484-4583

Authorized Official
Title or Position	:	PHYSICAL TRAINER OWNER
Name	:	MRS. SUZANNE M SKIBINSKI
Credential	:	DPT
Telephone Number	:	315-484-9497

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	08/22/2020

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