Provider Demographics
NPI:1053842575
Name:WALDRON PHYSIOTHERAPY, PLLC
Entity type:Organization
Organization Name:WALDRON PHYSIOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:315-503-1057
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-0480
Mailing Address - Country:US
Mailing Address - Phone:315-503-1057
Mailing Address - Fax:315-409-7708
Practice Address - Street 1:103 CHARLIES PL
Practice Address - Street 2:
Practice Address - City:CHITTENANGO
Practice Address - State:NY
Practice Address - Zip Code:13037-1080
Practice Address - Country:US
Practice Address - Phone:315-503-1057
Practice Address - Fax:315-409-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-26
Last Update Date:2017-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021540-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy