Healthcare Provider Details

I. General information

NPI: 1326094780
Provider Name (Legal Business Name): AMY NOLAN PTMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2733 WEHRLE DR
WILLIAMSVILLE NY
14221-7348
US

IV. Provider business mailing address

2374 HOBBLEBUSH LN
LAKE VIEW NY
14085-9447
US

V. Phone/Fax

Practice location:
  • Phone: 716-532-2258
  • Fax: 716-532-2321
Mailing address:
  • Phone: 716-532-2258
  • Fax: 716-532-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number026398
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: