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General NPI Number Information
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NPI Number | 1275511206
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Entity Type | Organization
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Legal Business Name | WHEATFIELD PHYSICAL THERAPY P.C.
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Dates
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Enumeration Date | 01/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3571 NIAGARA FALLS BLVD
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-1200
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Country | US
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Telephone | 716-695-7848
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Fax | 716-695-3012
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Provider Business Mailing Address
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Address Line | 3571 NIAGARA FALLS BLVD
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City | NORTH TONAWANDA
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State | NY
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Zip | 14120-1200
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Country | US
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Telephone | 716-695-7848
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Fax | 716-695-3012
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Authorized Official
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Title or Position | CO-OWNER
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Name | MR. MARK MILLEVILLE
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Credential | PT
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Telephone | 716-695-7848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 011248-1
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License Number State | NY
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