Provider Demographics
NPI:1053885848
Name:TSO, WILLIAM GRANT
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GRANT
Last Name:TSO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 VIRGINIA STREET STE 1
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1450
Mailing Address - Country:US
Mailing Address - Phone:716-332-4838
Mailing Address - Fax:716-882-1200
Practice Address - Street 1:531 VIRGINIA STREET STE 1
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1450
Practice Address - Country:US
Practice Address - Phone:716-332-4838
Practice Address - Fax:716-882-1200
Is Sole Proprietor?:No
Enumeration Date:2019-01-15
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037791225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist