Provider Demographics
NPI:1154549756
Name:NIAGARA PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:NIAGARA PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOERMER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:716-754-7220
Mailing Address - Street 1:732 CAYUGA ST
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:NY
Mailing Address - Zip Code:14092-1721
Mailing Address - Country:US
Mailing Address - Phone:716-754-7220
Mailing Address - Fax:716-754-9218
Practice Address - Street 1:732 CAYUGA ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:NY
Practice Address - Zip Code:14092-1721
Practice Address - Country:US
Practice Address - Phone:716-754-7220
Practice Address - Fax:716-754-9218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20224970174400000X
NY011771-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0560Medicare ID - Type UnspecifiedPHYSICAL THERAPY
NYBA0560Medicare PIN