Healthcare Provider Details

I. General information

NPI: 1174605174
Provider Name (Legal Business Name): TRICIA LYN KELLY BELL PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N MAIN ST
WARSAW NY
14569-1025
US

IV. Provider business mailing address

6501 COWIE RD
WYOMING NY
14591-9560
US

V. Phone/Fax

Practice location:
  • Phone: 585-786-2233
  • Fax: 585-786-1268
Mailing address:
  • Phone: 585-237-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4394411
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: