Healthcare Provider Details

I. General information

NPI: 1902996051
Provider Name (Legal Business Name): JOLIE MANDELL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOLIE LANGE PT

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

276 W MAIN ST
FREDONIA NY
14063-2234
US

IV. Provider business mailing address

276 W MAIN ST
FREDONIA NY
14063-2234
US

V. Phone/Fax

Practice location:
  • Phone: 716-680-8180
  • Fax: 716-680-8181
Mailing address:
  • Phone: 716-680-8180
  • Fax: 716-680-8181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0210331
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number8129
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: