Healthcare Provider Details

I. General information

NPI: 1497904817
Provider Name (Legal Business Name): GRETCHEN LYN WURL PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GRETCHEN LYN DEXHEIMER PT, DPT

II. Dates (important events)

Enumeration Date: 09/10/2008
Last Update Date: 09/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST
BUFFALO NY
14215-3021
US

IV. Provider business mailing address

5107 TUSCARORA RD
NIAGARA FALLS NY
14304-1165
US

V. Phone/Fax

Practice location:
  • Phone: 716-898-5040
  • Fax: 716-898-3259
Mailing address:
  • Phone: 716-957-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number029815-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: