1215965397 NPI number — WALLKILL PHYSICAL THERAPY, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215965397 NPI number — WALLKILL PHYSICAL THERAPY, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALLKILL PHYSICAL THERAPY, PLLC
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:
1215965397
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 336
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALLKILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12589-0336
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-895-9003
Provider Business Mailing Address Fax Number:
845-895-9006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 STATE ROUTE 208
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALLKILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12589-3712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-895-9003
Provider Business Practice Location Address Fax Number:
845-895-9006
Provider Enumeration Date:
06/29/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHNEIDER
Authorized Official First Name:
LORI
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER/MANAGER, PHYSICAL THERAPIST
Authorized Official Telephone Number:
845-895-9003

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  009042 , 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: 1255379525 . This is a "NPI INDIVIDUAL PROVIDER #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11574902 . This is a "CAQH #" identifier . This identifiers is of the category "OTHER".