MEDICARE: DREW TYLER ANTOLIK PT

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
1	225100000X	Physical Therapist	043044	NY

General Provider Information

NPI Number	:	1487148540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DREW TYLER ANTOLIK PT

Provider Business Mailing Address
First Line	:	1299 PORTLAND AVE STE 10
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-2727
Country	:	US
Telephone Number	:	585-286-9200
Fax Number	:	585-286-9203

Provider Business Practice Location Address
First Line	:	1299 PORTLAND AVE STE 10
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-2727
Country	:	US
Telephone Number	:	585-286-9200
Fax Number	:	585-286-9203

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2018
Last Update Date	:	06/21/2018

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