Provider Demographics
NPI:1457492316
Name:FACCINI, DAVID JOSEPH JR (PTA, LMT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JOSEPH
Last Name:FACCINI
Suffix:JR
Gender:M
Credentials:PTA, LMT
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Mailing Address - Street 1:146 63RD ST
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-3820
Mailing Address - Country:US
Mailing Address - Phone:716-283-1910
Mailing Address - Fax:716-283-1910
Practice Address - Street 1:146 63RD ST
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-3820
Practice Address - Country:US
Practice Address - Phone:716-283-1910
Practice Address - Fax:716-283-1910
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2013-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY002736-1225200000X
NY014257-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist