Provider Demographics
NPI:1104899640
Name:CHRISTOPHER PAGE PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:CHRISTOPHER PAGE PHYSICAL THERAPY P.C.
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:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:315-768-3721
Mailing Address - Street 1:36 ROOSEVELT DR
Mailing Address - Street 2:
Mailing Address - City:WHITESBORO
Mailing Address - State:NY
Mailing Address - Zip Code:13492-1550
Mailing Address - Country:US
Mailing Address - Phone:315-768-3721
Mailing Address - Fax:315-768-7658
Practice Address - Street 1:36 ROOSEVELT DR
Practice Address - Street 2:
Practice Address - City:WHITESBORO
Practice Address - State:NY
Practice Address - Zip Code:13492-1550
Practice Address - Country:US
Practice Address - Phone:315-768-3721
Practice Address - Fax:315-768-7658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013419-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01595335Medicaid
NY01595335Medicaid