Healthcare Provider Details

I. General information

NPI: 1447007208
Provider Name (Legal Business Name): WALTER JOSEPH TOMAKA III PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E AND WEST RD
WEST SENECA NY
14224-3604
US

IV. Provider business mailing address

1200 EAST AND WEST RD. ARTICLE 16 CLINIC WALTER TOMAKA III
WEST SENECA NY
14224-3604
US

V. Phone/Fax

Practice location:
  • Phone: 716-517-2000
  • Fax:
Mailing address:
  • Phone: 716-517-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number007935-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: