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NICOLE DERUE PHYSICAL THERAPY P.C. NPI 1053503185


NPI Information

NPI: 1053503185
Provider Name: NICOLE DERUE PHYSICAL THERAPY P.C.

Doing Business As: FAIRWAY PHYSICAL THERAPY NORTH

Classification: Clinic/Center - 261QP2000X
Entity Type: Organization

Specialization: Physical Therapy

Address:
573 S MAIN ST
CENTRAL SQUARE, NY
ZIP 13036
Phone: (315) 676-3826
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NICOLE DERUE PHYSICAL THERAPY P.C. is a physical therapy clinic center in Central Square, NY. The provider is an entity, facility, or distinct part of a facility providing diagnostic and treatment services related to physical rehabilitation. Physical therapy is a dynamic profession with an established theoretical and scientific base and widespread clinical applications in the restoration, maintenance, and promotion of optimal physical function. Physical therapists and physical therapist assistants are licensed health care professionals who are experts in the movement system and help individuals maintain, restore, and improve movement, activity, and functioning, thereby enabling optimal performance and enhancing health, well-being, and quality of life. Their services prevent, minimize, or eliminate impairments of body functions and structures, activity limitations, and participation restrictions. Physical therapy is provided for individuals of all ages who have or may develop impairments, activity limitations, and participation restrictions related to (1) conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems or (2) the negative effects attributable to unique personal and environmental factors as they relate to human performance. NICOLE DERUE PHYSICAL THERAPY P.C. NPI is 1053503185. The provider is registered as an organization entity type.
The provider Is Doing Business As Fairway Physical Therapy North.

The provider's business location address is:

573 S MAIN ST
CENTRAL SQUARE, NY
ZIP 13036-785
Phone: (315) 676-3826
Fax: (315) 676-3402

The provider's authorized official is Nicole Blythe Derue .
The authorized official title is President and has the following contact phone number (315) 676-3826.

The enumeration date for this NPI number is 8/13/2007 and was last updated on 11/21/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1261QP2000XClinic/CenterPhysical Therapy0590998NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1BA1215MEDICARE PINNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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