Provider Demographics
NPI:1295972172
Name:KAISER PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:KAISER PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PT
Authorized Official - Phone:716-652-1803
Mailing Address - Street 1:268 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-1655
Mailing Address - Country:US
Mailing Address - Phone:716-652-1803
Mailing Address - Fax:716-652-6101
Practice Address - Street 1:268 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST AURORA
Practice Address - State:NY
Practice Address - Zip Code:14052-1655
Practice Address - Country:US
Practice Address - Phone:716-652-1803
Practice Address - Fax:716-652-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX005775111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1190Medicare UPIN