Provider Demographics
NPI:1023183290
Name:DONNA A GULICK AND PETER H YOUNG PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:DONNA A GULICK AND PETER H YOUNG PHYSICAL THERAPY PC
Other - Org Name:ORTHOSPORTS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:A
Authorized Official - Last Name:GULICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:716-839-3705
Mailing Address - Street 1:3970 HARLEM RD
Mailing Address - Street 2:
Mailing Address - City:SNYDER
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-839-3705
Mailing Address - Fax:716-839-2347
Practice Address - Street 1:3970 HARLEM RD
Practice Address - Street 2:
Practice Address - City:SNYDER
Practice Address - State:NY
Practice Address - Zip Code:14226
Practice Address - Country:US
Practice Address - Phone:716-839-3705
Practice Address - Fax:716-839-2347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00011187501OtherUNIVERA
NYAA0231Medicare ID - Type Unspecified