Stacy Lynn Wentworth, PT
Individual provider Active NPI Physical Therapist · Leroy, NY
NPI 1104908029 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104908029
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapist 225100000X
- License
- 0229541 (NY)
- Practice address
- 3 West Ave
Leroy, NY 14482 - Phone
- (585) 768-4550
- Fax
- (585) 768-2335
- NPI assigned
- Oct 19, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0229541 | NY | MD | Physical Therapist |
| 022954 | NY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Genesee Valley Physical Therapy & Sports Rehab., P.C. | Physical Therapist | Current |
Accepting new patients |
| Human Performance and Rehabilitation Centers, Inc. | Past | Accepting new patients | |
| Human Performance and Rehabilitation Centers, Inc. | Physical Therapist | Past | Accepting new patients |
Locations
5 Alva Pl
Batavia, NY 14020
Phone (585) 343-9496
3 West Ave
Le Roy, NY 14482
Phone (585) 224-5179
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 0229541 | NY | Yes |
Addresses
Primary practice location
3 West Ave
Leroy, NY 14482
Mailing address
38 Ridge Meadows Dr
Spencerport, NY 14559
Phone (585) 349-1455
Other names
- Miss Stacy Lynn Defazio
Other providers in Leroy, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.