| NPI | 1477089662 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BROCK LISTER Owner 716-523-1783 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2000X Clinic/Center Physical Therapy (Licence: FL 31894) |
| Enumeration Date | 2017-05-07 |
| Last Update Date | 2017-05-07 |