Provider Demographics
NPI:1346206133
Name:BRITTONFIELD PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:BRITTONFIELD PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PETER
Authorized Official - Last Name:RICCELLI
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:315-234-7322
Mailing Address - Street 1:4939 BRITTONFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:E SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9208
Mailing Address - Country:US
Mailing Address - Phone:315-234-7322
Mailing Address - Fax:315-634-3264
Practice Address - Street 1:4939 BRITTONFIELD PKWY
Practice Address - Street 2:
Practice Address - City:E SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9208
Practice Address - Country:US
Practice Address - Phone:315-234-7322
Practice Address - Fax:315-634-3264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0177291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0512Medicare UPIN