Basic Information
| Provider Information | |||||||||
| NPI: | 1225330392 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SALT CITY PHYSICAL THERAPY, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 W FAYETTE ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132042856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154721488 | ||||||||
| FaxNumber: | 3154761792 | ||||||||
| Practice Location | |||||||||
| Address1: | 5795 WIDEWATERS PARKWAY | ||||||||
| Address2: | SUITE 1A | ||||||||
| City: | DEWITT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132141846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152001800 | ||||||||
| FaxNumber: | 3152001802 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2010 | ||||||||
| LastUpdateDate: | 04/15/2011 | ||||||||
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| AuthorizedOfficialLastName: | CARDI | ||||||||
| AuthorizedOfficialFirstName: | TODD | ||||||||
| AuthorizedOfficialMiddleName: | JOSEPH | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3152001800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 021825 | NY | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.