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General NPI Number Information
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NPI Number | 1558322784
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Entity Type | Organization
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Legal Business Name | FITNESS SPORTS AND PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 07/07/2017
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Provider Practice Location Address
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Address Line | 4063 N BUFFALO ST
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City | ORCHARD PARK
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State | NY
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Zip | 14127-2442
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Country | US
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Telephone | 716-662-2949
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Fax | 716-662-3673
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Provider Business Mailing Address
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Address Line | 4063 N BUFFALO ST
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City | ORCHARD PARK
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State | NY
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Zip | 14127-2442
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Country | US
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Telephone | 716-662-2949
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Fax | 716-662-3673
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Authorized Official
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Title or Position | PRESIDENT PHYSICAL THERAPIST
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Name | MR. TERRY JOHN WHIELDON
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Credential | PHYSICAL THERAPIST
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Telephone | 716-662-2949
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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 | 0079921
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License Number State | NY
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