Provider Demographics
NPI:1104158831
Name:PHYSICAL THERAPY OF ROCHESTER, LLC
Entity type:Organization
Organization Name:PHYSICAL THERAPY OF ROCHESTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:BEALE
Authorized Official - Last Name:OAKDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:585-544-0350
Mailing Address - Street 1:1255 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14621
Mailing Address - Country:US
Mailing Address - Phone:585-544-0350
Mailing Address - Fax:585-544-0352
Practice Address - Street 1:1255 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621
Practice Address - Country:US
Practice Address - Phone:585-544-0350
Practice Address - Fax:585-544-0352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-05
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022636-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA6139Medicare UPIN