Provider Demographics
NPI:1730431404
Name:CAPITAL DISTRICT THERAPY SERVICES
Entity type:Organization
Organization Name:CAPITAL DISTRICT THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GINA
Authorized Official - Middle Name:FC
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:518-357-9984
Mailing Address - Street 1:14 GARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12306-1107
Mailing Address - Country:US
Mailing Address - Phone:518-357-9984
Mailing Address - Fax:
Practice Address - Street 1:14 GARRISON AVE
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12306-1107
Practice Address - Country:US
Practice Address - Phone:518-357-9984
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-05
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009200-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1376799767OtherINDIVIDUAL NPI NUMBER