Provider Demographics
NPI:1578796892
Name:VOLLMER, SHAUN (DPT)
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:
Last Name:VOLLMER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 WEHRLE DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-7381
Mailing Address - Country:US
Mailing Address - Phone:716-932-7525
Mailing Address - Fax:716-630-9200
Practice Address - Street 1:2801 WEHRLE DR
Practice Address - Street 2:SUITE 7
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7381
Practice Address - Country:US
Practice Address - Phone:716-932-7525
Practice Address - Fax:716-630-9200
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031844-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400005725Medicare PIN
NYJ400047361Medicare PIN