Provider Demographics
NPI:1083694145
Name:KAISER PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:KAISER PHYSICAL THERAPY PC
Other - Org Name:THE SOURCE FOR HEALTH & WELL LIVING
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER AND PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:DC PT
Authorized Official - Phone:716-652-1803
Mailing Address - Street 1:121 ELM ST
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2535
Mailing Address - Country:US
Mailing Address - Phone:716-652-1803
Mailing Address - Fax:716-652-1951
Practice Address - Street 1:121 ELM ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-2535
Practice Address - Country:US
Practice Address - Phone:716-652-1803
Practice Address - Fax:716-652-1951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00020087901OtherUNIV
NY002084681OtherBCBS
NYAA1030OtherMEDICARE ID- TYPE UNSPECIFIED
NY006084683OtherBCBS
NY9303777OtherIA