Healthcare Provider Details

I. General information

NPI: 1952401408
Provider Name (Legal Business Name): BUFFALO PHYSICAL THERAPY & SPORTS REHABILITATION, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5264 MAIN ST
WILLIAMSVILLE NY
14221-5326
US

IV. Provider business mailing address

5264 MAIN ST
WILLIAMSVILLE NY
14221-5326
US

V. Phone/Fax

Practice location:
  • Phone: 716-632-9200
  • Fax: 716-632-1730
Mailing address:
  • Phone: 716-632-9200
  • Fax: 716-632-1730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD P WHITE
Title or Position: PRESIDENT
Credential: PT
Phone: 716-632-9200