Provider Demographics
NPI:1558327619
Name:PODRAZA, JEFFERY THOMAS (PT)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:THOMAS
Last Name:PODRAZA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8705 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6317
Mailing Address - Country:US
Mailing Address - Phone:716-631-1212
Mailing Address - Fax:716-631-1363
Practice Address - Street 1:8705 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6317
Practice Address - Country:US
Practice Address - Phone:716-631-1212
Practice Address - Fax:716-631-1363
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021643-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00027516501OtherUNIVERA HEALTH CARE
NY000626303002OtherBLUE CROSS & BLUE SHIELD