Provider Demographics
NPI:1700604741
Name:VINCEK, ANDREW MARK (PT, DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:MARK
Last Name:VINCEK
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BRIGHAM RD
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1000
Mailing Address - Country:US
Mailing Address - Phone:716-679-7447
Mailing Address - Fax:
Practice Address - Street 1:12 BRIGHAM RD
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1000
Practice Address - Country:US
Practice Address - Phone:716-679-7447
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist