Provider Demographics
NPI:1679588487
Name:REHABILITATION SPECIALISTS PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPE
Entity Type:Organization
Organization Name:REHABILITATION SPECIALISTS PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPE
Other - Org Name:ECH-LANGUAGE PATHOLOGY AND REGISTERED NURSING, PLLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CWYNAR
Authorized Official - Suffix:
Authorized Official - Credentials:PT DPT
Authorized Official - Phone:716-485-3227
Mailing Address - Street 1:774 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-2609
Mailing Address - Country:US
Mailing Address - Phone:716-665-1166
Mailing Address - Fax:866-902-1160
Practice Address - Street 1:774 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701
Practice Address - Country:US
Practice Address - Phone:716-665-1166
Practice Address - Fax:866-902-1160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03787322Medicaid
NYAA0830OtherPTAN