Provider Demographics
NPI:1386799138
Name:IRACI, SAMMY III (PT)
Entity type:Individual
Prefix:MR
First Name:SAMMY
Middle Name:
Last Name:IRACI
Suffix:III
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:PO BOX 896
Mailing Address - Street 2:
Mailing Address - City:GETZVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14068-0896
Mailing Address - Country:US
Mailing Address - Phone:716-565-0818
Mailing Address - Fax:888-401-2425
Practice Address - Street 1:6245 SHERIDAN DR
Practice Address - Street 2:STE 112
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-4834
Practice Address - Country:US
Practice Address - Phone:716-565-0818
Practice Address - Fax:888-401-2425
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024809225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB8377Medicare PIN