Healthcare Provider Details

I. General information

NPI: 1326305921
Provider Name (Legal Business Name): MRS. EILEEN DUELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 SILVER SPRINGS DR
BALLSTON SPA NY
12020-3425
US

IV. Provider business mailing address

12 SILVER SPRINGS DR
BALLSTON SPA NY
12020-3425
US

V. Phone/Fax

Practice location:
  • Phone: 518-885-8031
  • Fax:
Mailing address:
  • Phone: 518-885-8031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number000337-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: