Basic Information
| Provider Information | |||||||||
| NPI: | 1407128192 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FISHKILL PHYSICAL THERAPY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2531 ROUTE 52 | ||||||||
| Address2: | |||||||||
| City: | HOPEWELL JUNCTION | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125333227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455924747 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2531 ROUTE 52 | ||||||||
| Address2: | |||||||||
| City: | HOPEWELL JUNCTION | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125333227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455924747 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2012 | ||||||||
| LastUpdateDate: | 12/18/2012 | ||||||||
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| AuthorizedOfficialLastName: | RIFINO | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 8455924747 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | PROF. | ||||||||
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| AuthorizedOfficialCredential: | P.T. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 1467583500 | 01 | NY | IND. NPI | OTHER |