MEDICARE: SHANE SETLOCK

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	036644	NY

General Provider Information

NPI Number	:	1730808585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANE SETLOCK

Provider Business Mailing Address
First Line	:	40 SAINT ANTHONY ST
Second Line	:
City	:	LANCASTER
State	:	NY
Zip	:	14086-2388
Country	:	US
Telephone Number	:	716-983-6010
Fax Number	:

Provider Business Practice Location Address
First Line	:	9570 TRANSIT RD
Second Line	:
City	:	EAST AMHERST
State	:	NY
Zip	:	14051-1188
Country	:	US
Telephone Number	:	716-688-5709
Fax Number	:

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

Provider Enumeration Date	:	08/24/2022
Last Update Date	:	08/24/2022

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Directions to “ SHANE SETLOCK ” Practice Location

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