Basic Information
| Provider Information | |||||||||
| NPI: | 1043225915 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BOUTON PHYSICAL THERAPY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 221 S JAMES ST | ||||||||
| Address2: | BOUTON PHYSICAL THERAPY | ||||||||
| City: | ROME | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153371436 | ||||||||
| FaxNumber: | 3153361437 | ||||||||
| Practice Location | |||||||||
| Address1: | 221 S JAMES ST | ||||||||
| Address2: | BOUTON PHYSICAL THERAPY | ||||||||
| City: | ROME | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3153371436 | ||||||||
| FaxNumber: | 3153361437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2006 | ||||||||
| LastUpdateDate: | 05/30/2008 | ||||||||
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| AuthorizedOfficialLastName: | BOUTON | ||||||||
| AuthorizedOfficialFirstName: | R. CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3153371436 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.