Provider Demographics
NPI:1861534281
Name:PEDIATRIC PHYSICAL THERAPY SERVICES, PLLC
Entity type:Organization
Organization Name:PEDIATRIC PHYSICAL THERAPY SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:STAMPE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:585-427-7610
Mailing Address - Street 1:3255 BRIGHTON HENRIETTA TOWN LINE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2806
Mailing Address - Country:US
Mailing Address - Phone:585-427-7610
Mailing Address - Fax:585-427-7410
Practice Address - Street 1:3255 BRIGHTON HENRIETTA TOWN LINE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2806
Practice Address - Country:US
Practice Address - Phone:585-427-7610
Practice Address - Fax:585-427-7410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G0189088590OtherBLUE CHOICE
60002OtherBLUE CROSS BLUE SHIELD