Amber Lee

 
 2015-06-25 19:59:15 EDT 
 To: 19549226864 
 Page: 02/628
 From: Lauris Rigdon 
 Plan of Care 
 Patient: 
 Susan Smith
 ONONDAGA 
 DOB: 
 1986-04-17 Sex: F 
 PHYSICAL THERAPY 
 Visit: 
 2015-05-26 Visit # 1 
 Provider: 
 Maria Stalder, PT, DPT 
 NPI# 
 1992425722 
 Clinic Details 
 Case Details 
 Clinic 
 Address 
 Injury Description 
 Date of Plan of Care 
 Onondaga Physical Therapy 
 15 East Genesee Street 
 SIJ dysfunction 
 6/7/2023 
 Suite 130 
 Injury Onset Date 
 3156355xxx 
 M99.04, M25.551 
 2023-03-10
 Fax # 
 Referring Physician 
 3152853628 
 MICHAEL MINCOLLA 
 Assessment 
 Patient: Susan Smith (DOB: 1986-04-17) 
 Treated by Maria Stalder, PT. DPT (License #049147) 
 DOS: 2018-10-05
 Page 1 of 28 of Plan of Care
