Provider Demographics
NPI:1962788844
Name:INDE PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:INDE PHYSICAL THERAPY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOBZIEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:607-727-4895
Mailing Address - Street 1:733 GLENMARY DR
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-2644
Mailing Address - Country:US
Mailing Address - Phone:607-727-4895
Mailing Address - Fax:
Practice Address - Street 1:733 GLENMARY DR
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-2644
Practice Address - Country:US
Practice Address - Phone:607-727-4895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0141512251S0007X, 2251X0800X
PAPT007930L2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Single Specialty