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Organization
ON TRACK PHYSICAL THERAPY, LLC
Active
Organization
ON TRACK PHYSICAL THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LOUIS BOISVERT PT (MEMBER)
(607) 797-5414
Entity
Organization
Contact information
Practice address
120 PLAZA DR, SUITE E, VESTAL, NY 13850-3640
(607) 797-5414
(607) 797-6537
Mailing address
120 PLAZA DR, SUITE E, VESTAL, NY 13850-3640
(607) 797-5414
(607) 797-6537
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
008038-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02721415
—
NY
01
—
166468
EXCELLUS
NY
01
—
3949264
AETNA HMO
NY
01
—
6697064
GHI PPO
NY
01
—
7782695
AETNA
NY
01
—
S791
CDPHP
NY
Enumeration date
01/10/2007
Last updated
08/22/2020
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