Provider Demographics
NPI:1528122793
Name:COUNTY PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:COUNTY PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-256-0820
Mailing Address - Street 1:83 N. CHESTNUT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561
Mailing Address - Country:US
Mailing Address - Phone:845-256-0820
Mailing Address - Fax:845-256-9028
Practice Address - Street 1:83 N CHESTNUT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1408
Practice Address - Country:US
Practice Address - Phone:845-256-0820
Practice Address - Fax:845-256-9028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY38096225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
126306OtherWELLCARE
0030500OtherHEALTHNET
10032239OtherCDPHP
ANC1566OtherOXFORD
NY02-075-390Medicaid
Q31921OtherEMPIRE BLUE CROSS BLUE SH
222976633OtherUNITED HEALTH PLAN
130308OtherMPN
2C3846OtherPHS
528582OtherAETNA US HEALTHCARE
29333OtherGHI HMO
43648OtherMVP
6602574OtherGHI
ANC1566OtherOXFORD