Healthcare Provider Details

I. General information

NPI: 1861315731
Provider Name (Legal Business Name): CARLY WEIGEL LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 GARDENVILLE PKWY
BUFFALO NY
14224-1387
US

IV. Provider business mailing address

40 GARDENVILLE PKWY
BUFFALO NY
14224-1387
US

V. Phone/Fax

Practice location:
  • Phone: 716-387-2515
  • Fax:
Mailing address:
  • Phone: 716-387-2515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number032731
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: