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Individual

ANNELISE MODICA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT DPT

Contact information

Practice address
3767 DELAWARE AVE, BUFFALO, NY 14217-1040
(716) 874-6175
(716) 874-6175
Mailing address
3767 DELAWARE AVE, BUFFALO, NY 14217-1040
(716) 874-6175
(716) 874-6175

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
044925
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
05909820
NY
Enumeration date
10/16/2019
Last updated
09/03/2024
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