Provider Demographics
NPI:1558369199
Name:MEYER, JOHN T (PT)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:T
Last Name:MEYER
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 1:3925 SHERIDAN DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-0000
Mailing Address - Country:US
Mailing Address - Phone:716-250-9999
Mailing Address - Fax:716-250-4177
Practice Address - Street 1:3925 SHERIDAN DRIVE
Practice Address - Street 2:SUITE 110
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-0000
Practice Address - Country:US
Practice Address - Phone:716-250-9999
Practice Address - Fax:716-250-4177
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA23052030012251X0800X
NY02298912251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAANTHEM BC/BSOther278580
NY000528521001OtherBLUES
VAANTHEM BC/BSOther278580