Individual
PHILLIP BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
30 HATFIELD LN, SUITE 203, GOSHEN, NY 10924-6766
(845) 615-2222
Mailing address
PO BOX 239, GOSHEN, NY 10924-0239
(845) 615-1585
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
008174
NY
Other
Enumeration date
12/11/2012
Last updated
12/11/2012
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