Provider Demographics
NPI:1770827545
Name:ZWACK, ERIN (LMT)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:ZWACK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2982 DELAWARE AVE REAR
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217-2324
Mailing Address - Country:US
Mailing Address - Phone:716-877-2858
Mailing Address - Fax:716-877-2859
Practice Address - Street 1:2982 DELAWARE AVE REAR
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2324
Practice Address - Country:US
Practice Address - Phone:716-877-2858
Practice Address - Fax:716-877-2859
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0904173C00000X
NY022871-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No173C00000XOther Service ProvidersReflexologist