Provider Demographics
NPI:1508836776
Name:PRIVITERA, PETER (PT DPT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:PRIVITERA
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 412
Mailing Address - Street 2:STEP BY STEP PHYSICAL THERAPY PC
Mailing Address - City:WARSAW
Mailing Address - State:NY
Mailing Address - Zip Code:14569
Mailing Address - Country:US
Mailing Address - Phone:585-786-8700
Mailing Address - Fax:585-786-2659
Practice Address - Street 1:3 HANDLEY ST
Practice Address - Street 2:STEP BY STEP PHYSICAL THERAPY PC
Practice Address - City:PERRY
Practice Address - State:NY
Practice Address - Zip Code:14530
Practice Address - Country:US
Practice Address - Phone:585-237-3050
Practice Address - Fax:585-237-3952
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000627491001OtherBCBS WESTERN NEW YORK
NY02471209Medicaid
NY000627491001OtherBCBS WESTERN NEW YORK
NYRA0529Medicare ID - Type Unspecified