Individual provider Active NPI

Mark Jospeh Siedlecki, PT, DPT

  • Physical Therapist
  • Williamsville, NY
National Provider Identifier
1124689542
Registry record updated Jul 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
043405 Issued in NY
Practice address
111 N Maplemere Rd Ste 100
Williamsville, NY 14221-3182
Phone
(716) 204-3200
Fax
(716) 204-4337
NPI assigned
Jun 26, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 043405 NY Primary

Addresses

Primary practice location

111 N Maplemere Rd Ste 100
Williamsville, NY 14221-3182

Mailing address

4225 Genesee St Ste 400
Cheektowaga, NY 14225-1994
Phone (716) 204-3200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200319002244 NY Practitioner - Physical Therapist in Private Practice 3476981747 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Body Mechanix Physical Therapy PLLCGroup PAC ID 8022064393, 6 clinicians

Practice addresses (Care Compare)

5848 Snyder Dr
Lockport, NY 14094-9497
Phone (716) 433-0070

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
043405NYMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Body Mechanix Physical Therapy PLLC Physical Therapist CurrentSince Feb 12, 2020 Accepting new patients
Western New York Physical and Occupational Therapy Group PLLC Physical Therapist PastSince Feb 12, 2020 Accepting new patients

Locations

5848 Snyder Dr
Lockport, NY 14094
Phone (716) 433-0070

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1561507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783382400000",
    "number": "1124689542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 GENESEE ST STE 400",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142251994",
            "telephone_number": "716-204-3200",
            "fax_number": "716-204-4337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 N MAPLEMERE RD STE 100",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "142213182",
            "telephone_number": "716-204-3200",
            "fax_number": "716-204-4337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIEDLECKI",
        "first_name": "MARK",
        "middle_name": "JOSPEH",
        "name_prefix": "Dr.",
        "credential": "PT, DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-26",
        "last_updated": "2026-07-07",
        "certification_date": "2026-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "043405",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamsville, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.