Provider Demographics
NPI:1306115407
Name:DAVID R ROOT D C P T LLC
Entity type:Organization
Organization Name:DAVID R ROOT D C P T LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROOT DC PT
Authorized Official - Suffix:
Authorized Official - Credentials:DC PT
Authorized Official - Phone:716-366-2229
Mailing Address - Street 1:338 CENTRAL AVE
Mailing Address - Street 2:PO BOX 70
Mailing Address - City:DUNKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:14048-2100
Mailing Address - Country:US
Mailing Address - Phone:716-366-2229
Mailing Address - Fax:716-366-7874
Practice Address - Street 1:338 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:NY
Practice Address - Zip Code:14048-2100
Practice Address - Country:US
Practice Address - Phone:716-366-2229
Practice Address - Fax:716-366-7874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5002477111N00000X
NY4983811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty