Provider Demographics
NPI:1710021001
Name:SUSAN E BENNETT PT PC
Entity Type:Organization
Organization Name:SUSAN E BENNETT PT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:WUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-803-8220
Mailing Address - Street 1:2075 SHERIDAN DR STE D
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14223-1425
Mailing Address - Country:US
Mailing Address - Phone:716-803-8220
Mailing Address - Fax:716-874-1458
Practice Address - Street 1:2075 SHERIDAN DR STE D
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14223-1425
Practice Address - Country:US
Practice Address - Phone:716-803-8220
Practice Address - Fax:716-874-1458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0699Medicare ID - Type UnspecifiedMEDICARE GRP ID