Healthcare Provider Details

I. General information

NPI: 1235723677
Provider Name (Legal Business Name): SELECT REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OHIO ST
MEDINA NY
14103-1063
US

IV. Provider business mailing address

5334 GENESEE ST APT 1
BOWMANSVILLE NY
14026-1062
US

V. Phone/Fax

Practice location:
  • Phone: 585-798-2000
  • Fax:
Mailing address:
  • Phone: 716-474-6087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: JOSHUA ROBERT HOTZ
Title or Position: PHYSICAL THERAPIST ASSISTANT
Credential:
Phone: 716-474-6087