Healthcare Provider Details

I. General information

NPI: 1053712471
Provider Name (Legal Business Name): JANELLE BUELL P.T., DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 STATE ROUTE 31
VERONA NY
13478-2913
US

IV. Provider business mailing address

19 EARL MNR
DEANSBORO NY
13328-1101
US

V. Phone/Fax

Practice location:
  • Phone: 315-829-2520
  • Fax:
Mailing address:
  • Phone: 315-404-1842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number038075-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: