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Organization
LAKE COUNTRY PHYSICAL THERAPY & SPORTSCARE, PC
Active
Organization
LAKE COUNTRY PHYSICAL THERAPY & SPORTSCARE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. ZOE FACKELMAN PT (PRESIDENT)
(585) 396-1400
Entity
Organization
Contact information
Practice address
241 PARRISH ST, SUITE A, CANANDAIGUA, NY 14424-1727
(585) 396-1400
(585) 396-3368
Mailing address
241 PARRISH ST, SUITE A, CANANDAIGUA, NY 14424-1727
(585) 396-1400
(585) 396-3368
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01608671
—
NY
01
—
5776378
RCIPPAE
NY
01
—
G0185178590
BLUE CHOICE
NY
Enumeration date
02/12/2007
Last updated
04/20/2008
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