MEDICARE: LAURIE LYNNE MITTLEFEHLDT 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	225100000X	Physical Therapist	008297-1	NY

General Provider Information

NPI Number	:	1912038506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE LYNNE MITTLEFEHLDT PT

Provider Business Mailing Address
First Line	:	74 GRASSPOINTE DR
Second Line	:
City	:	AMHERST
State	:	NY
Zip	:	14228-2820
Country	:	US
Telephone Number	:	716-691-3468
Fax Number	:

Provider Business Practice Location Address
First Line	:	2235 MILLERSPORT HWY
Second Line	:
City	:	GETZVILLE
State	:	NY
Zip	:	14068-1219
Country	:	US
Telephone Number	:	716-504-1231
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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