| NPI | 1679812747 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE DAVIS Physical Therapist 315-358-4028 |
| Organization Subpart ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 022935) |
| Enumeration Date | 2013-02-08 |
| Last Update Date | 2025-06-27 |