Provider Demographics
NPI:1063701506
Name:AMBORSKI, BEVERLY (LMT)
Entity type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:AMBORSKI
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4477 ARONDALE DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6222
Mailing Address - Country:US
Mailing Address - Phone:716-634-1218
Mailing Address - Fax:
Practice Address - Street 1:9146 MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARENCE
Practice Address - State:NY
Practice Address - Zip Code:14031-1929
Practice Address - Country:US
Practice Address - Phone:716-939-0365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024088172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist