Organization
CREEKSIDE PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ELLEN BETH WILSON P.T. (PRESIDENT)
(716) 532-8129
Entity
Organization
Contact information
Practice address
14318 ROUTE 62, COLLINS, NY 14034-9788
(716) 532-8129
(716) 532-9201
Mailing address
14318 ROUTE 62, COLLINS, NY 14034-9788
(716) 532-8129
(716) 532-9201
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
008212
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00010244901
UNIVERA
NY
01
—
000623245003
BLUE CROSS/BLUE SHIELD OF
NY
01
—
822231
EMPIRE
NY
01
—
9308583
INDEPENDENT HEALTH
NY
Enumeration date
09/05/2007
Last updated
05/01/2008
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