Provider Demographics
NPI:1518441005
Name:CALABRESE, ANTHONY THOMAS
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:THOMAS
Last Name:CALABRESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4134 LORING AVE
Mailing Address - Street 2:
Mailing Address - City:BLASDELL
Mailing Address - State:NY
Mailing Address - Zip Code:14219-2716
Mailing Address - Country:US
Mailing Address - Phone:716-572-7270
Mailing Address - Fax:
Practice Address - Street 1:4134 LORING AVE
Practice Address - Street 2:
Practice Address - City:BLASDELL
Practice Address - State:NY
Practice Address - Zip Code:14219-2716
Practice Address - Country:US
Practice Address - Phone:716-572-7270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011615-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant