Provider Demographics
NPI:1043738446
Name:PETERS, ALEXANDER PAUL (PT, DPT, SCS, ATC)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:PAUL
Last Name:PETERS
Suffix:
Gender:M
Credentials:PT, DPT, SCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 763
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14231-0763
Mailing Address - Country:US
Mailing Address - Phone:716-202-2477
Mailing Address - Fax:
Practice Address - Street 1:5087 BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4013
Practice Address - Country:US
Practice Address - Phone:716-354-3212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0034542255A2300X
NY046346225100000X
TX1345441225100000X
2251S0007X
TX87782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports