Provider Demographics
NPI:1598164410
Name:UBILES, VICTOR RYAN (DPT)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:RYAN
Last Name:UBILES
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 1:8980 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:GASPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14067-9406
Mailing Address - Country:US
Mailing Address - Phone:716-251-7007
Mailing Address - Fax:
Practice Address - Street 1:6101 ROBINSON RD
Practice Address - Street 2:SOUTH SUITE
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-8920
Practice Address - Country:US
Practice Address - Phone:716-210-3103
Practice Address - Fax:716-210-3103
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037786225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000545277002OtherBCBS PROVIDER ID
NY06011834Medicaid
11189661OtherINDEPENDENT HEALTH PROVIDER ID
3590202OtherINDEPENDENT HEALTH COMPANY ID