Basic Information
Provider Information
NPI: 1225460769
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SONRICKER
FirstName: MATTHEW
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DPT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2801 WEHRLE DR
Address2: SUITE 7
City: WILLIAMSVILLE
State: NY
PostalCode: 142217381
CountryCode: US
TelephoneNumber: 7166309700
FaxNumber: 7166309200
Practice Location
Address1: 2801 WEHRLE DR
Address2: SUITE 7
City: WILLIAMSVILLE
State: NY
PostalCode: 142217381
CountryCode: US
TelephoneNumber: 7166309700
FaxNumber: 7166309200
Other Information
ProviderEnumerationDate: 08/07/2013
LastUpdateDate: 08/07/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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