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General NPI Number Information
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NPI Number | 1366305070
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Entity Type | Individual
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Provider Name | MICHELLE B FAX PTA
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Gender | Female
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Dates
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Enumeration Date | 12/09/2025
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 192 PARK CLUB LN
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City | WILLIAMSVILLE
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State | NY
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Zip | 14221-5270
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Country | US
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Telephone | 716-632-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 8929 GASKIN RD
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City | CLARENCE
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State | NY
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Zip | 14031-1412
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Country | US
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Telephone | 716-632-9200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2770586
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License Number State | NY
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