Provider Demographics
NPI:1740947142
Name:NOTEBAERT, PEYTON DARE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:PEYTON
Middle Name:DARE
Last Name:NOTEBAERT
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 1:6219 TONAWANDA CREEK RD APT 16
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-7903
Mailing Address - Country:US
Mailing Address - Phone:315-690-6730
Mailing Address - Fax:
Practice Address - Street 1:711 PARK AVE
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:NY
Practice Address - Zip Code:14103-1078
Practice Address - Country:US
Practice Address - Phone:585-798-4344
Practice Address - Fax:585-798-0439
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-19
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic