Provider Demographics
NPI:1548413370
Name:PHYSICAL THERAPY SERVICES OF NIAGARA, PLLC
Entity Type:Organization
Organization Name:PHYSICAL THERAPY SERVICES OF NIAGARA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-523-1383
Mailing Address - Street 1:3341 SUMMERSET CT
Mailing Address - Street 2:
Mailing Address - City:N TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-1277
Mailing Address - Country:US
Mailing Address - Phone:716-523-1383
Mailing Address - Fax:716-693-5464
Practice Address - Street 1:3341 SUMMERSET CT
Practice Address - Street 2:
Practice Address - City:N TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14120-1277
Practice Address - Country:US
Practice Address - Phone:716-523-1383
Practice Address - Fax:716-693-5464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016258-12251P0200X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty