Provider Demographics
NPI:1073974820
Name:BAKOWSKI, MICHAEL (PT DPT)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:BAKOWSKI
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 UNION RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1400
Mailing Address - Country:US
Mailing Address - Phone:716-656-8600
Mailing Address - Fax:716-656-1560
Practice Address - Street 1:2100 UNION RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1400
Practice Address - Country:US
Practice Address - Phone:716-656-8600
Practice Address - Fax:716-656-1560
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1073974820Medicare PIN