1336477066 NPI number — SRM PHYSICAL THERAPY, PC

Table of content: (NPI 1336477066)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336477066 NPI number — SRM PHYSICAL THERAPY, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SRM PHYSICAL THERAPY, PC
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:
SRM WOMEN'S HEALTH PHYSICAL THERAPY
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:
1336477066
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 MAURERBROOK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FISHKILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12524-1134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
646-220-2458
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 SCHUMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10546-1111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
646-220-2458
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RIORDAN
Authorized Official First Name:
SUAN
Authorized Official Middle Name:
JANET
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
646-220-2458

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X , with the licence number:  025608-1 , 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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