Basic Information
| Provider Information | |||||||||
| NPI: | 1912000498 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRIS | ||||||||
| FirstName: | PETER | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 CARTER STREET | ||||||||
| Address2: | |||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5853394793 | ||||||||
| FaxNumber: | 5853364845 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 EMPIRE DR | ||||||||
| Address2: | EMPIRE DRIVE HEALTH CENTER | ||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166686352 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 012075 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 00011283007 | 01 | NY | UNIVERA # | OTHER | 0145195 | 01 | NY | GHI PPO # | OTHER | P00357162 | 01 | NY | MEDICARE RAILROAD # | OTHER | 050422000005 | 01 | NY | FIDELIS CARE # | OTHER | 159884FT | 01 | NY | PREFERRED CARE # | OTHER | 000611325005 | 01 | NY | HEALTH NOW BCBS # | OTHER | 0191145 | 01 | NY | IHA # | OTHER |