Provider Demographics
NPI:1467622431
Name:USRH D.C & P.T., P.C.
Entity Type:Organization
Organization Name:USRH D.C & P.T., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:KACZMAREK
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PT
Authorized Official - Phone:716-656-0200
Mailing Address - Street 1:2448 UNION RD
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-2230
Mailing Address - Country:US
Mailing Address - Phone:716-656-0200
Mailing Address - Fax:716-656-0055
Practice Address - Street 1:2448 UNION RD
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227-2230
Practice Address - Country:US
Practice Address - Phone:716-656-0200
Practice Address - Fax:716-656-0055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-06
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018590-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000626820003OtherBLUE CROSS & BLUE SHIELD
NY9311595OtherINDEPENDENT HEALTH
NY00025998703OtherUNIVERA
NY00025998703OtherUNIVERA