Provider Demographics
NPI:1922528660
Name:WOLFLEY, BRYAN (SPT)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:WOLFLEY
Suffix:
Gender:M
Credentials:SPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12230 MORTONS CORNERS RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-9737
Mailing Address - Country:US
Mailing Address - Phone:716-548-4980
Mailing Address - Fax:
Practice Address - Street 1:5848 SNYDER DR
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-9497
Practice Address - Country:US
Practice Address - Phone:716-433-0070
Practice Address - Fax:716-433-1171
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042110225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist