Provider Demographics
NPI:1003141862
Name:CREATIVE PARTNERS IN PHYSICAL THERAPY AND SPEECH LANGUAGE PATHOLOGY
Entity Type:Organization
Organization Name:CREATIVE PARTNERS IN PHYSICAL THERAPY AND SPEECH LANGUAGE PATHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HEUSER
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:716-570-1662
Mailing Address - Street 1:1728 BRALEY RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14174-9733
Mailing Address - Country:US
Mailing Address - Phone:716-570-1662
Mailing Address - Fax:
Practice Address - Street 1:1728 BRALEY RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:NY
Practice Address - Zip Code:14174-9733
Practice Address - Country:US
Practice Address - Phone:716-570-1662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-13
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency