Provider Demographics
NPI:1083328934
Name:IMPULSE PHYSICAL THERAPY, PLLC
Entity Type:Organization
Organization Name:IMPULSE PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, SCS, ATC
Authorized Official - Phone:716-202-2477
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:
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:716-503-2260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-05
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty