Basic Information
| Provider Information | |||||||||
| NPI: | 1629288675 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OHLSTEN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | PTA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 428 VASSAR RD | ||||||||
| Address2: | |||||||||
| City: | ALTONA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129102304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8025246534 | ||||||||
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| Practice Location | |||||||||
| Address1: | 22 NEW YORK RD | ||||||||
| Address2: | |||||||||
| City: | PLATTSBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129033981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5185613803 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 08/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 004404-1 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.