Provider Demographics
NPI:1841516770
Name:PIERCE, PHOEBE JEAN (LMT)
Entity type:Individual
Prefix:MISS
First Name:PHOEBE
Middle Name:JEAN
Last Name:PIERCE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2875 UNION RD STE 350
Mailing Address - Street 2:
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14227-1461
Mailing Address - Country:US
Mailing Address - Phone:716-681-9455
Mailing Address - Fax:716-681-9456
Practice Address - Street 1:2875 UNION RD. SUITE 350
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14227
Practice Address - Country:US
Practice Address - Phone:716-681-9455
Practice Address - Fax:716-681-9456
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2010-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020586-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist