Provider Demographics
NPI:1982025094
Name:SWIATEK PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:SWIATEK PHYSICAL THERAPY PLLC
Other - Org Name:PHOENIX PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SWIATEK
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:716-907-2791
Mailing Address - Street 1:4498 MAIN ST
Mailing Address - Street 2:SUITE 24
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3826
Mailing Address - Country:US
Mailing Address - Phone:716-839-1550
Mailing Address - Fax:716-839-1696
Practice Address - Street 1:4498 MAIN ST
Practice Address - Street 2:SUITE 24
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14226-3826
Practice Address - Country:US
Practice Address - Phone:716-839-1550
Practice Address - Fax:716-839-1696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-17
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0284781261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02806577Medicaid
NYRB1900Medicare PIN