Provider Demographics
NPI:1952375990
Name:PERFORMANCE SPORTS PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:PERFORMANCE SPORTS PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:HORRIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:716-674-1509
Mailing Address - Street 1:560 CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2157
Mailing Address - Country:US
Mailing Address - Phone:716-674-1509
Mailing Address - Fax:716-674-1787
Practice Address - Street 1:560 CENTER RD
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2157
Practice Address - Country:US
Practice Address - Phone:716-674-1509
Practice Address - Fax:716-674-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-15
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00011197201OtherUNIVERA
NYAA0571Medicare ID - Type UnspecifiedMEDICARE