Provider Demographics
NPI:1306986781
Name:KAUDERER, AMY L (DPT)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:L
Last Name:KAUDERER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6572 SLAYTON SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-1137
Mailing Address - Country:US
Mailing Address - Phone:716-434-9260
Mailing Address - Fax:716-298-9391
Practice Address - Street 1:10158 NIAGARA FALLS BLVD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2793
Practice Address - Country:US
Practice Address - Phone:716-298-9390
Practice Address - Fax:716-298-9391
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026371-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RA6657Medicare PIN