Organization
NICOLE DERUE PHYSICAL THERAPY P.C.
Active
Other names
Fairway Physical Therapy North
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NICOLE BLYTHE DERUE P.T (PRESIDENT)
(315) 676-3826
Entity
Organization
Contact information
Practice address
573 S MAIN ST, CENTRAL SQUARE, NY 13036-9785
(315) 676-3826
(315) 676-3402
Mailing address
573 S MAIN ST, CENTRAL SQUARE, NY 13036-9785
(315) 676-3826
(315) 676-3402
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
0590998
NY
Other
Enumeration date
08/13/2007
Last updated
11/21/2007
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