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NPI Code Detail

MEDICARE: NIAGARA THERAPY L.L.C.

MEDICARE: NIAGARA THERAPY L.L.C.
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
1225X00000XOccupational Therapist
2261QH0700XHearing and Speech Clinic/Center
3261QP2000XPhysical Therapy Clinic/Center
4261QR0400XRehabilitation Clinic/CenterOC006865LPA

General Provider Information

NPI Number : 1760634166
Entity Type Code : Organization
Provider Name (Legal Business Name) : NIAGARA THERAPY L.L.C.
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 : MANAGER/MEMBER
Name : MS. MICHELLE LYNN MIODUSZEWSKI
Credential : OTR/L
Telephone Number : 814-464-0627
Provider Enumeration Date : 10/16/2008
Last Update Date : 04/02/2019

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Directions to “NIAGARA THERAPY L.L.C. ” Practice Location

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