Provider Demographics
NPI:1164822078
Name:CENTRAL PHYSICAL & OCCUPATIONAL THERAPY, PLLC
Entity type:Organization
Organization Name:CENTRAL PHYSICAL & OCCUPATIONAL THERAPY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-706-0030
Mailing Address - Street 1:5183 LYLE DR
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:NY
Mailing Address - Zip Code:13041-9721
Mailing Address - Country:US
Mailing Address - Phone:888-706-0030
Mailing Address - Fax:888-817-4702
Practice Address - Street 1:5183 LYLE DR
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:NY
Practice Address - Zip Code:13041-9721
Practice Address - Country:US
Practice Address - Phone:888-706-0030
Practice Address - Fax:888-817-4702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021324-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty