Provider Demographics
NPI:1477848810
Name:LINGLE & MAZUR PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:LINGLE & MAZUR PHYSICAL THERAPY, PC
Other - Org Name:DUBOIS PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OWNER,PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:LINGLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DPT,MSBS,MTC
Authorized Official - Phone:716-731-2195
Mailing Address - Street 1:2111 SAWYER DR
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-2975
Mailing Address - Country:US
Mailing Address - Phone:716-731-2195
Mailing Address - Fax:716-731-4862
Practice Address - Street 1:2111 SAWYER DR
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2975
Practice Address - Country:US
Practice Address - Phone:716-731-2195
Practice Address - Fax:716-731-4862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0263541225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty