Healthcare Provider Details

I. General information

NPI: 1548289861
Provider Name (Legal Business Name): MARY KAY PRESUTTI PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 N MAIN ST
WELLSVILLE NY
14895-1150
US

IV. Provider business mailing address

21 COURT ST
BELMONT NY
14813-1001
US

V. Phone/Fax

Practice location:
  • Phone: 585-593-4011
  • Fax:
Mailing address:
  • Phone: 585-307-7140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number005513-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: