Provider Demographics
NPI:1477572980
Name:BUFFALO BACK & NECK PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:BUFFALO BACK & NECK PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT -SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT,
Authorized Official - Phone:716-836-2225
Mailing Address - Street 1:1060 NIAGARA FALLS BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150
Mailing Address - Country:US
Mailing Address - Phone:716-836-2225
Mailing Address - Fax:716-836-2712
Practice Address - Street 1:1060 NIAGARA FALLS BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150
Practice Address - Country:US
Practice Address - Phone:716-836-2225
Practice Address - Fax:716-836-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018465-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty