Healthcare Provider Details

I. General information

NPI: 1891564753
Provider Name (Legal Business Name): SUSAN KATHLEEN WEHLING DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2023
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 GRAND ISLAND BLVD
GRAND ISLAND NY
14072-2249
US

IV. Provider business mailing address

6781 SHAWNEE RD
NORTH TONAWANDA NY
14120-9504
US

V. Phone/Fax

Practice location:
  • Phone: 716-773-4323
  • Fax: 716-773-9418
Mailing address:
  • Phone: 716-523-0296
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number012250-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: