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General NPI Number Information
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NPI Number | 1326728866
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Entity Type | Organization
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Legal Business Name | AWAKEN PERFORMANCE REHAB LLC
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Dates
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Enumeration Date | 07/19/2023
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 4476 MAIN ST STE 110
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City | AMHERST
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State | NY
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Zip | 14226-4463
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Country | US
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Telephone | 716-246-4806
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Fax | 716-303-7014
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Provider Business Mailing Address
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Address Line | 177 STONERIDGE CT
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City | EAST AURORA
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State | NY
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Zip | 14052-2039
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Country | US
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Telephone | 716-270-3267
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Fax | 716-303-7014
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Authorized Official
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Title or Position | OWNER/PHYSICAL THERAPIST
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Name | DR. GREGORY MATTHEW LOWE
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Credential | PT, DPT, CERT. MDT
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Telephone | 716-270-3267
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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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