Provider Demographics
NPI:1417135278
Name:FAMILY CARE PHYSICAL THERAPY AND FITNESS PLLC
Entity Type:Organization
Organization Name:FAMILY CARE PHYSICAL THERAPY AND FITNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMMY
Authorized Official - Middle Name:F
Authorized Official - Last Name:IRACI
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:716-565-0818
Mailing Address - Street 1:PO BOX 896
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-0896
Mailing Address - Country:US
Mailing Address - Phone:716-565-0818
Mailing Address - Fax:888-401-2425
Practice Address - Street 1:6245 SHERIDAN DR
Practice Address - Street 2:SUITE 112
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4834
Practice Address - Country:US
Practice Address - Phone:716-565-0818
Practice Address - Fax:888-401-2425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-04
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024809261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy