Provider Demographics
NPI:1700917903
Name:DANTZLER, WILLIE ABBOTT (PHYSICAL THERAPIST A)
Entity Type:Individual
Prefix:MR
First Name:WILLIE
Middle Name:ABBOTT
Last Name:DANTZLER
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 ACADEMY RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14211
Mailing Address - Country:US
Mailing Address - Phone:716-893-4061
Mailing Address - Fax:
Practice Address - Street 1:150 STAHL RD
Practice Address - Street 2:SUMMIT EDUCATIONAL RESOURCES
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068
Practice Address - Country:US
Practice Address - Phone:716-629-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0055361225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant