Provider Demographics
NPI:1255338133
Name:PIEKARSKI, BRIAN M (PT)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
Last Name:PIEKARSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 GREENHAVEN TERRACE
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-5547
Mailing Address - Country:US
Mailing Address - Phone:716-213-0772
Mailing Address - Fax:716-213-0773
Practice Address - Street 1:350 GREENHAVEN TERRACE
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-5547
Practice Address - Country:US
Practice Address - Phone:716-213-0772
Practice Address - Fax:716-213-0773
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT008075225100000X
NY017798-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB0917Medicare PIN
GA116769Medicare ID - Type UnspecifiedN GA MEDICARE