Provider Demographics
NPI:1821516451
Name:SCIBETTA, KEVIN MATTHEW (DPT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MATTHEW
Last Name:SCIBETTA
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 1:360 CAMPUS DRIVE APT #1
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226
Mailing Address - Country:US
Mailing Address - Phone:716-936-2153
Mailing Address - Fax:
Practice Address - Street 1:9095 MAIN ST SUITE B
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031
Practice Address - Country:US
Practice Address - Phone:716-839-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-04
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042115-1225100000X
NY042115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist