Active NPI
Dalton Fucik, PT, DPT
- Physical Therapist
- Hamburg, NY
National Provider Identifier
1033803598
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 050717
- Practice address
- 4650 Southwestern Blvd
Hamburg, NY 14075-1939 - Phone
- (716) 648-2450
- NPI assigned
- Jun 7, 2023
- Last updated
- Dec 4, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 050717 | NY | Primary |
Addresses
Primary practice location
4650 Southwestern Blvd
Hamburg, NY 14075-1939
Mailing address
2116 Mill Rd
West Falls, NY 14170-9752
Phone (210) 667-6420
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 050717 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1701648000000",
"number": "1033803598",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2116 MILL RD",
"city": "WEST FALLS",
"state": "NY",
"postal_code": "141709752",
"telephone_number": "210-667-6420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4650 SOUTHWESTERN BLVD",
"city": "HAMBURG",
"state": "NY",
"postal_code": "140751939",
"telephone_number": "716-648-2450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUCIK",
"first_name": "DALTON",
"credential": "PT, DPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-06-07",
"last_updated": "2023-12-04",
"certification_date": "2023-12-04",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "050717",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hamburg, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.