Basic Information
| Provider Information | |||||||||
| NPI: | 1700917903 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DANTZLER | ||||||||
| FirstName: | WILLIE | ||||||||
| MiddleName: | ABBOTT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PHYSICAL THERAPIST A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 107 ACADEMY RD | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168934061 | ||||||||
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| Practice Location | |||||||||
| Address1: | 150 STAHL RD | ||||||||
| Address2: | SUMMIT EDUCATIONAL RESOURCES | ||||||||
| City: | GETZVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166293400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 0055361 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.