Provider Demographics
NPI:1669406625
Name:ALBION PHYSICAL THERAPY AND SPORTS INJURY REHABILITATION
Entity type:Organization
Organization Name:ALBION PHYSICAL THERAPY AND SPORTS INJURY REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:BOHNET
Authorized Official - Suffix:III
Authorized Official - Credentials:PT
Authorized Official - Phone:716-560-0515
Mailing Address - Street 1:2 LYNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LYNDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14098-9664
Mailing Address - Country:US
Mailing Address - Phone:716-765-2615
Mailing Address - Fax:
Practice Address - Street 1:311 S MAIN ST
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:NY
Practice Address - Zip Code:14411-1602
Practice Address - Country:US
Practice Address - Phone:716-560-0515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011920-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0924Medicare PIN