Provider Demographics
NPI:1700635711
Name:VANFLEET PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:VANFLEET PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:VANFLEET
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-905-4155
Mailing Address - Street 1:12050 MILL ST
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:NY
Mailing Address - Zip Code:14590-1228
Mailing Address - Country:US
Mailing Address - Phone:315-905-4155
Mailing Address - Fax:315-905-4312
Practice Address - Street 1:12050 MILL ST
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:NY
Practice Address - Zip Code:14590-1228
Practice Address - Country:US
Practice Address - Phone:315-905-4155
Practice Address - Fax:315-905-4312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy