Provider Demographics
NPI:1194791137
Name:SZYMANSKI, WALTER R (PT)
Entity type:Individual
Prefix:
First Name:WALTER
Middle Name:R
Last Name:SZYMANSKI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6301 TRANSIT RD
Mailing Address - Street 2:
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-1051
Mailing Address - Country:US
Mailing Address - Phone:716-684-0400
Mailing Address - Fax:716-683-7028
Practice Address - Street 1:6301 TRANSIT RD
Practice Address - Street 2:
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-1051
Practice Address - Country:US
Practice Address - Phone:716-684-0400
Practice Address - Fax:716-683-7028
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004548225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00719273Medicaid
NY00011174501OtherUNIVERA
NY000606838002OtherBLUE CROSS BLUE SHIELD
NY040511000709OtherFIDELIS
NY6602441OtherGHI
NY9350776OtherIHA
NY820393OtherMANAGED PHYSICAL NETWORK
NY00011174501OtherUNIVERA