Basic Information
| Provider Information | |||||||||
| NPI: | 1730343955 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN NEW YORK PHYSICAL THERAPY & CHIROPRACTIC, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 240 RIVERSIDE DR | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 137902732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077988800 | ||||||||
| FaxNumber: | 6077988801 | ||||||||
| Practice Location | |||||||||
| Address1: | 240 RIVERSIDE DR | ||||||||
| Address2: | SUITE 4 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 137902732 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077988800 | ||||||||
| FaxNumber: | 6077988801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2008 | ||||||||
| LastUpdateDate: | 02/09/2009 | ||||||||
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| AuthorizedOfficialLastName: | ROUHANA | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIROPRACTOR/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6077988800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.C. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 026333-1 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.