Basic Information
| Provider Information | |||||||||
| NPI: | 1548290943 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BUFFALO REHAB GROUP PHYSICAL THERAPY AND OCCUPATIONAL THERAPY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | BOX 8000 DEPT 314 | ||||||||
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| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142670002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162130772 | ||||||||
| FaxNumber: | 7163245004 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 UNION RD | ||||||||
| Address2: | |||||||||
| City: | WEST SENECA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142241400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166568600 | ||||||||
| FaxNumber: | 7166561560 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 05/31/2022 | ||||||||
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| AuthorizedOfficialLastName: | HAMMEL | ||||||||
| AuthorizedOfficialFirstName: | RAYMOND | ||||||||
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| AuthorizedOfficialTitleorPosition: | CO-OWNER/CFO | ||||||||
| AuthorizedOfficialTelephone: | 7162130772 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.