1861490823 NPI number — BRANDON PARTENZA PHYSICAL THERAPIST

Table of content: BRANDON PARTENZA PHYSICAL THERAPIST (NPI 1861490823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861490823 NPI number — BRANDON PARTENZA PHYSICAL THERAPIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARTENZA
Provider First Name:
BRANDON
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHYSICAL THERAPIST
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861490823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 FRENCH RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HARTFORD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13413-1037
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-266-0010
Provider Business Mailing Address Fax Number:
315-266-0147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 FRENCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HARTFORD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13413-1037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-266-0010
Provider Business Practice Location Address Fax Number:
315-266-0147
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  015432-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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