Organization
LIFT BRIDGE PHYSICAL THERAPY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLEEN RICCIONE MS PT (OWNER, PHYSICAL THERAPIST)
(585) 797-5308
Entity
Organization
Contact information
Practice address
52 WINCANTON DR, FAIRPORT, NY 14450-3847
(585) 797-5308
Mailing address
52 WINCANTON DR, FAIRPORT, NY 14450-3847
(585) 797-5308
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265599252
—
NY
Enumeration date
07/10/2022
Last updated
07/10/2022
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