Provider Demographics
NPI:1275511206
Name:WHEATFIELD PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:WHEATFIELD PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLEVILLE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:716-695-7848
Mailing Address - Street 1:3571 NIAGARA FALLS BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1200
Mailing Address - Country:US
Mailing Address - Phone:716-695-7848
Mailing Address - Fax:716-695-3012
Practice Address - Street 1:3571 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-1200
Practice Address - Country:US
Practice Address - Phone:716-695-7848
Practice Address - Fax:716-695-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011248-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty