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NPI Code Detail

MEDICARE: NIAGARA THERAPY, LLC

MEDICARE: NIAGARA THERAPY, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QP2000XPhysical Therapy Clinic/CenterPT001131EPA

General Provider Information

NPI Number : 1427580836
Entity Type Code : Organization
Provider Name (Legal Business Name) : NIAGARA THERAPY, LLC
Provider Business Mailing Address
First Line : 2631 W 8TH ST
Second Line :
City : ERIE
State : PA
Zip : 16505-4034
Country : US
Telephone Number : 814-464-0627
Fax Number : 814-464-0629
Provider Business Practice Location Address
First Line : 2631 W 8TH ST
Second Line :
City : ERIE
State : PA
Zip : 16505-4034
Country : US
Telephone Number : 814-464-0627
Fax Number : 814-464-0629
Authorized Official
Title or Position : OWNER
Name : MICHELLE MIODUSZEWSKI
Credential : MS, OTR/L
Telephone Number : 814-464-0627
Provider Enumeration Date : 04/03/2017
Last Update Date : 04/03/2017

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Directions to “NIAGARA THERAPY, LLC ” Practice Location

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