Healthcare Provider Details

I. General information

NPI: 1619523636
Provider Name (Legal Business Name): GRAND ISLAND BODYWORKS PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2099 GRAND ISLAND BLVD STE B
GRAND ISLAND NY
14072
US

IV. Provider business mailing address

2099 GRAND ISLAND BLVD STE B
GRAND ISLAND NY
14072
US

V. Phone/Fax

Practice location:
  • Phone: 716-773-3300
  • Fax: 716-773-3303
Mailing address:
  • Phone: 716-773-3300
  • Fax: 716-773-3303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: LISA Z TRUNZO
Title or Position: SOLE MBR/OWNER
Credential: PT
Phone: 716-773-3300