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Organization
FITNESS SPORTS AND PHYSICAL THERAPY PC
Active
Organization
FITNESS SPORTS AND PHYSICAL THERAPY PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TERRY JOHN WHIELDON PHYSICAL THERAPIST (PRESIDENT PHYSICAL THERAPIST)
(716) 662-2949
Entity
Organization
Contact information
Practice address
4063 N BUFFALO ST, ORCHARD PARK, NY 14127-2442
(716) 662-2949
(716) 662-3673
Mailing address
4063 N BUFFALO ST, ORCHARD PARK, NY 14127-2442
(716) 662-2949
(716) 662-3673
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
0079921
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00011189901
UNIVEX
NY
01
—
006103111
BLUE CROSS BLUE SHIELD
NY
01
—
9352186
INDEPENDENT HEALTH
NY
Enumeration date
03/29/2006
Last updated
07/07/2017
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