Provider Demographics
NPI:1326208315
Name:ANGOLA PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:ANGOLA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:MCGARRITY
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:716-549-1099
Mailing Address - Street 1:8505 ERIE RD.
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:NY
Mailing Address - Zip Code:14006-9703
Mailing Address - Country:US
Mailing Address - Phone:716-549-1099
Mailing Address - Fax:716-549-2293
Practice Address - Street 1:8505 ERIE RD.
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:NY
Practice Address - Zip Code:14006-9703
Practice Address - Country:US
Practice Address - Phone:716-549-1099
Practice Address - Fax:716-549-2293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010200-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01916265Medicaid
BA0443Medicare PIN