Provider Demographics
NPI:1760228274
Name:WILLIAMSVILLE PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:WILLIAMSVILLE PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:PROSPERO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:716-276-0556
Mailing Address - Street 1:PO BOX 29
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-0029
Mailing Address - Country:US
Mailing Address - Phone:716-276-0556
Mailing Address - Fax:
Practice Address - Street 1:8705 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6317
Practice Address - Country:US
Practice Address - Phone:716-276-0556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty