Provider Demographics
NPI:1285346072
Name:TORRES, PHILIP TYLER (OTR)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:TYLER
Last Name:TORRES
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 WAVEY WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-1501
Mailing Address - Country:US
Mailing Address - Phone:845-741-9457
Mailing Address - Fax:
Practice Address - Street 1:1406 KINGS HIGHWAY
Practice Address - Street 2:
Practice Address - City:SUGAR LOAF
Practice Address - State:NY
Practice Address - Zip Code:10981
Practice Address - Country:US
Practice Address - Phone:845-827-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-23
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist