Provider Demographics
NPI:1700993706
Name:GEMMER, JASON C (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:C
Last Name:GEMMER
Suffix:
Gender:M
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 PARKHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14150-8809
Mailing Address - Country:US
Mailing Address - Phone:716-908-6779
Mailing Address - Fax:716-837-2069
Practice Address - Street 1:1615 AMHERST MANOR DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14221-2040
Practice Address - Country:US
Practice Address - Phone:716-908-6779
Practice Address - Fax:716-837-2069
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0266501225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA5748Medicare ID - Type Unspecified