Provider Demographics
NPI:1326728866
Name:AWAKEN PERFORMANCE REHAB LLC
Entity Type:Organization
Organization Name:AWAKEN PERFORMANCE REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CERT MDT
Authorized Official - Phone:716-270-3267
Mailing Address - Street 1:177 STONERIDGE CT
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-2039
Mailing Address - Country:US
Mailing Address - Phone:716-270-3267
Mailing Address - Fax:716-303-7014
Practice Address - Street 1:4476 MAIN ST STE 110
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-4463
Practice Address - Country:US
Practice Address - Phone:716-246-4806
Practice Address - Fax:716-303-7014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy