Provider Demographics
NPI:1891391199
Name:WESTERN NEW YORK FITNESS REHABILITATION, PT, PLLC
Entity Type:Organization
Organization Name:WESTERN NEW YORK FITNESS REHABILITATION, PT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:716-563-4811
Mailing Address - Street 1:425 MEYER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-1954
Mailing Address - Country:US
Mailing Address - Phone:716-563-4811
Mailing Address - Fax:
Practice Address - Street 1:425 MEYER RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-1954
Practice Address - Country:US
Practice Address - Phone:716-563-4811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy