1861534281 NPI number — PEDIATRIC PHYSICAL THERAPY SERVICES, PLLC

Table of content: (NPI 1861534281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861534281 NPI number — PEDIATRIC PHYSICAL THERAPY SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC PHYSICAL THERAPY SERVICES, 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:
1861534281
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3255 BRIGHTON HENRIETTA TOWN LINE RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
ROCHESTER
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14623-2806
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
585-427-7610
Provider Business Mailing Address Fax Number:
585-427-7410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3255 BRIGHTON HENRIETTA TOWN LINE RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14623-2806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
585-427-7610
Provider Business Practice Location Address Fax Number:
585-427-7410
Provider Enumeration Date:
02/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STAMPE
Authorized Official First Name:
PIA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
585-427-7610

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G0189088590 . This is a "BLUE CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 60002 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com