MEDICARE: EQUAL STANDING PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist
2	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1679389910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EQUAL STANDING PT

Provider Business Mailing Address
First Line	:	1250 NIAGARA ST STE 200
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14213-1776
Country	:	US
Telephone Number	:	716-325-0427
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 NIAGARA ST STE 200
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14213-1776
Country	:	US
Telephone Number	:	716-325-0427
Fax Number	:

Authorized Official
Title or Position	:	COOWNER
Name	:	DR. KATHLEEN ROSS
Credential	:	PT DPT
Telephone Number	:	716-325-0427

Provider Enumeration Date	:	12/10/2024
Last Update Date	:	12/10/2024

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Directions to “EQUAL STANDING PT ” Practice Location

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