Healthcare Provider Details

I. General information

NPI: 1639393838
Provider Name (Legal Business Name): ALICEMAE BELL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

464 MAIN ST
AGAWAM MA
01001-1826
US

IV. Provider business mailing address

23 PEMBROKE LN
AGAWAM MA
01001-2463
US

V. Phone/Fax

Practice location:
  • Phone: 413-786-8000
  • Fax:
Mailing address:
  • Phone: 413-821-9581
  • Fax: 860-687-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number4739
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: