Jac Samuel Dorris
Individual provider Active NPI Physical Therapy Assistant · Lewiston, NY
NPI 1407535693 · NPPES record last updated Jul 14, 2023
Key facts
- NPI
- 1407535693
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Therapy Assistant 225200000X
- Practice address
- 5828 Lewiston Road
Lewiston, NY 14092 - Phone
- (716) 298-2900
- NPI assigned
- Jul 14, 2023
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 0 | NY | Yes |
Addresses
Primary practice location
5828 Lewiston Road
Lewiston, NY 14092
Mailing address
262 Erin Road
Medina, NY 14103
Phone (716) 940-3946
Other providers in Lewiston, NY
- Christopher Ryan Dekker
- Robert F Divencenzo
- Leigh Dixon
- Steven Doermer
- Elizabeth Anne Doherty
- Eric Thomas Duchscherer
- Timothy George Dyster
- Jake Eberth
- Andrea Nicole Edwards
- Samir El-Chehabi
All providers in Lewiston, NY · Physical Therapy Assistant in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.