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General NPI Number Information
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NPI Number | 1245809953
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Entity Type | Organization
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Legal Business Name | PRESCRIBED MOTION PHYSICAL THERAPY EXERCISE, PLLC
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Dates
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Enumeration Date | 06/18/2021
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Last Update Date | 06/18/2021
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Provider Practice Location Address
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Address Line | 5501 MAIN ST
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-6763
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Country | US
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Telephone | 315-292-3322
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Fax |
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Provider Business Mailing Address
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Address Line | 81 ROYCROFT BLVD
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City | BUFFALO
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State | NY
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Zip | 14226-4528
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Country | US
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Telephone | 315-292-3322
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AMANDA BEVILACQUA
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Credential | DPT
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Telephone | 315-292-3322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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