Basic Information
| Provider Information | |||||||||
| NPI: | 1750463188 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FAMILY PHYSICAL THERAPY PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 327 MILES AVENUE | ||||||||
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| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158821060 | ||||||||
| FaxNumber: | 3152952208 | ||||||||
| Practice Location | |||||||||
| Address1: | 1106 EAST GENESEE STREET | ||||||||
| Address2: | |||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158821060 | ||||||||
| FaxNumber: | 3152952208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FORGET | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
| AuthorizedOfficialMiddleName: | WILLIAM | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 3158821060 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT DPT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 021515 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.