Provider Demographics
NPI:1538421656
Name:ROCHESTER PHYSICAL THERAPY WELLNESS PLLC
Entity type:Organization
Organization Name:ROCHESTER PHYSICAL THERAPY WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:585-872-9669
Mailing Address - Street 1:159 W MAIN ST
Mailing Address - Street 2:LOWER LEVEL EAST
Mailing Address - City:WEBSTER
Mailing Address - State:NY
Mailing Address - Zip Code:14580-2960
Mailing Address - Country:US
Mailing Address - Phone:585-872-9669
Mailing Address - Fax:585-872-9449
Practice Address - Street 1:159 W MAIN ST
Practice Address - Street 2:LOWER LEVEL EAST
Practice Address - City:WEBSTER
Practice Address - State:NY
Practice Address - Zip Code:14580-2960
Practice Address - Country:US
Practice Address - Phone:585-872-9669
Practice Address - Fax:585-872-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-14
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018692225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty