=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194272799
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSEPH MICHAEL DELLAVALLE DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2016
-----------------------------------------------------
Last Update Date | 03/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1275 MAIN ST STE 120
-----------------------------------------------------
City | BUFFALO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14209-1911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-402-4920
-----------------------------------------------------
Fax | 716-322-5505
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 366
-----------------------------------------------------
City | TONAWANDA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14151-0366
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-402-4920
-----------------------------------------------------
Fax | 716-322-5505
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 040430
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------