| Organization Name: | CREEKSIDE PHYSICAL THERAPY PC |
| NPI Number: | 1891989661 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ELLEN BETH WILSON (PRESIDENT) |
| Mailing Address: | 14318 Route 62 Collins |
| State: | NY US |
| Postal Code: | 140349788 |
| Phone Number: | 7165328129 |
| Fax Number: | 7165329201 |
| NPI Enumeration Date: | 09/05/2007 |
| NPI Last Update Date: | 05/01/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2000X |
| License Number: | 008212 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Physical Therapy |
| Taxonomy Definition: | |