Provider Demographics
NPI:1083660765
Name:TRI-COUNTY PHYSICAL THERAPY, PC
Entity type:Organization
Organization Name:TRI-COUNTY PHYSICAL THERAPY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:KLANCER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-532-2258
Mailing Address - Street 1:104 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14070-1111
Mailing Address - Country:US
Mailing Address - Phone:716-532-2258
Mailing Address - Fax:716-532-2321
Practice Address - Street 1:104 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOWANDA
Practice Address - State:NY
Practice Address - Zip Code:14070-1111
Practice Address - Country:US
Practice Address - Phone:716-532-2258
Practice Address - Fax:716-532-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0286Medicare ID - Type Unspecified