Provider Demographics
NPI:1619192648
Name:FAMILY CARE PHYSICAL THERAPY, PC
Entity Type:Organization
Organization Name:FAMILY CARE PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT,SCS
Authorized Official - Phone:716-565-0818
Mailing Address - Street 1:2390 N FOREST RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-1294
Mailing Address - Country:US
Mailing Address - Phone:716-565-0818
Mailing Address - Fax:716-204-1218
Practice Address - Street 1:2390 N FOREST RD
Practice Address - Street 2:SUITE 3
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1294
Practice Address - Country:US
Practice Address - Phone:716-565-0818
Practice Address - Fax:716-204-1218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009097-1174400000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011185701OtherPHYSICAL THERAPY
NY00011185701OtherPHYSICAL THERAPY