Healthcare Provider Details

I. General information

NPI: 1558327619
Provider Name (Legal Business Name): JEFFERY THOMAS PODRAZA P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8705 SHERIDAN DR
WILLIAMSVILLE NY
14221-6317
US

IV. Provider business mailing address

8705 SHERIDAN DR
WILLIAMSVILLE NY
14221-6317
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-1212
  • Fax: 716-631-1363
Mailing address:
  • Phone: 716-631-1212
  • Fax: 716-631-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number021643-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: