Provider Demographics
NPI:1073782223
Name:VINK, LAURA LEE (PT MS)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LEE
Last Name:VINK
Suffix:
Gender:F
Credentials:PT MS
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:LEE
Other - Last Name:STALICA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 UNION ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224
Mailing Address - Country:US
Mailing Address - Phone:716-675-4444
Mailing Address - Fax:716-675-4446
Practice Address - Street 1:100 UNION ROAD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224
Practice Address - Country:US
Practice Address - Phone:716-675-4444
Practice Address - Fax:716-675-4446
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0278561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist