1528122793 NPI number — COUNTY PHYSICAL THERAPY LLC

Table of content: (NPI 1528122793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528122793 NPI number — COUNTY PHYSICAL THERAPY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY PHYSICAL THERAPY LLC
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:
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:
1528122793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
83 N. CHESTNUT ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
NEW PALTZ
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12561
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-256-0820
Provider Business Mailing Address Fax Number:
845-256-9028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
83 N CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
NEW PALTZ
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12561-1408
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-256-0820
Provider Business Practice Location Address Fax Number:
845-256-9028
Provider Enumeration Date:
12/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HENRY
Authorized Official First Name:
JAY
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICAL THERAPIST
Authorized Official Telephone Number:
845-256-0820

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  38096 , 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)

  • Identifier: 126306 . This is a "WELLCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0030500 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10032239 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: ANC1566 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02-075-390 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q31921 . This is a "EMPIRE BLUE CROSS BLUE SH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 222976633 . This is a "UNITED HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 130308 . This is a "MPN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2C3846 . This is a "PHS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 528582 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 29333 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43648 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6602574 . This is a "GHI" identifier . This identifiers is of the category "OTHER".




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