1184620262 NPI number — MONROE PHYSICAL THERAPY, LLP

Table of content: (NPI 1184620262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184620262 NPI number — MONROE PHYSICAL THERAPY, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONROE PHYSICAL THERAPY, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ROCHESTER SPORTS & PHYSICAL THERAPY II
Provider Other Organization Name Type Code:
3
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:
1184620262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 RED CREEK DR
Provider Second Line Business Mailing Address:
STE 210
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14623-4262
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-334-8090
Provider Business Mailing Address Fax Number:
585-334-8104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 RED CREEK DR
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14623-4262
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-334-8090
Provider Business Practice Location Address Fax Number:
585-334-8104
Provider Enumeration Date:
06/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
AUDYCKI
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
OWNER/PHYSICAL THERAPIST
Authorized Official Telephone Number:
585-227-2580

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  010363 , 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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