Provider Demographics
NPI:1871663591
Name:SEWERYN, ALICIA M (PT)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:SEWERYN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2438 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:KENMORE
Mailing Address - State:NY
Mailing Address - Zip Code:14217
Mailing Address - Country:US
Mailing Address - Phone:716-873-9154
Mailing Address - Fax:716-875-3796
Practice Address - Street 1:2438 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217
Practice Address - Country:US
Practice Address - Phone:716-873-9154
Practice Address - Fax:716-875-3796
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0217341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000626951001OtherBLUE CROSS
9311626OtherINDEPENDENT HEALTH
825107OtherEMPIRE
825107OtherEMPIRE
CC8618Medicare ID - Type Unspecified