Provider Demographics
NPI:1285998179
Name:JUVENTAS PHYSICAL OCCUPATIONAL & SPEECH THERAPY SERVICES PLLC
Entity type:Organization
Organization Name:JUVENTAS PHYSICAL OCCUPATIONAL & SPEECH THERAPY SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST/MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, MSPT
Authorized Official - Phone:607-377-7482
Mailing Address - Street 1:65 E MARKET ST STE 201
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2708
Mailing Address - Country:US
Mailing Address - Phone:607-377-7482
Mailing Address - Fax:607-962-6986
Practice Address - Street 1:65 E MARKET ST STE 201
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2708
Practice Address - Country:US
Practice Address - Phone:607-377-7482
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-26
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019336-1225100000X, 225100000X
NY012869-1225X00000X
NY020655-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty