Provider Demographics
NPI:1104012640
Name:ACCESS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:ACCESS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ENRICO
Authorized Official - Middle Name:
Authorized Official - Last Name:FROSOLONE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:716-284-4474
Mailing Address - Street 1:PO BOX 3299
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14240-3299
Mailing Address - Country:US
Mailing Address - Phone:716-284-4474
Mailing Address - Fax:716-284-4484
Practice Address - Street 1:2316 PINE AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-2338
Practice Address - Country:US
Practice Address - Phone:716-284-4474
Practice Address - Fax:716-284-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025797225100000X
010913-1225100000X
017075-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000628316001OtherBC/BS
NY9313114OtherIHA
NY03138341Medicaid
NY02726447Medicaid
NY00052890002OtherBC/BS
NY00052890002OtherBC/BS
NY03138341Medicaid