Organization
PREMIER PHYSICAL THERAPY OF THE FINGERLAKES, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MITCHELL ROBERT CARLSON P.T. (OWNER)
(585) 394-3920
Entity
Organization
Contact information
Practice address
229 PARRISH STREET, SUITE 220, CANANDAIGUA, NY 14424
(585) 394-3920
(585) 394-3997
Mailing address
229 PARRISH STREET, SUITE 220, CANANDAIGUA, NY 14424
(585) 394-3920
(585) 394-3997
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
014144-1
NY
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0185042370
EXCELLUS BLUE CHOICE
NY
01
—
020114144
EXCELLUS BC BS
NY
05
—
02632479
—
NY
01
—
145851FT
PREFERRED CARE
NY
01
—
601318000
OWCP
NY
01
—
7735556
AETNA
NY
01
—
DC4683
MEDICARE RAILROAD
NY
Enumeration date
04/06/2006
Last updated
06/11/2010
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