Provider Demographics
NPI:1124061908
Name:INTEGRATED PHYSICAL THERAPY OF ROCHESTER, LLC
Entity type:Organization
Organization Name:INTEGRATED PHYSICAL THERAPY OF ROCHESTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZASTAWRNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-392-2001
Mailing Address - Street 1:16 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HILTON
Mailing Address - State:NY
Mailing Address - Zip Code:14468-1211
Mailing Address - Country:US
Mailing Address - Phone:585-392-2001
Mailing Address - Fax:
Practice Address - Street 1:16 MAIN ST
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-1211
Practice Address - Country:US
Practice Address - Phone:585-392-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA0162Medicare UPIN