Provider Demographics
NPI:1578127510
Name:NIERTIT, ROBERT THOMAS (PTA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:THOMAS
Last Name:NIERTIT
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 CONISTON DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2117
Mailing Address - Country:US
Mailing Address - Phone:585-747-9536
Mailing Address - Fax:
Practice Address - Street 1:225 WEST AVE
Practice Address - Street 2:
Practice Address - City:HILTON
Practice Address - State:NY
Practice Address - Zip Code:14468-1253
Practice Address - Country:US
Practice Address - Phone:585-392-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010697225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant