Provider Demographics
NPI:1548506710
Name:FAME, RICHARD (PT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:FAME
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E HIGHLAND DR
Mailing Address - Street 2:MIDTOWN ATHLETIC-ROCHESTER GENERAL HOSPITAL
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-3008
Mailing Address - Country:US
Mailing Address - Phone:585-242-2395
Mailing Address - Fax:585-242-2396
Practice Address - Street 1:210 E HIGHLAND DR
Practice Address - Street 2:MIDTOWN ATHLETIC-ROCHESTER GENERAL HOSPITAL
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14610-3008
Practice Address - Country:US
Practice Address - Phone:585-242-2395
Practice Address - Fax:585-242-2396
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY015438225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist