Healthcare Provider Details

I. General information

NPI: 1720562374
Provider Name (Legal Business Name): KEVIN BUELL LPTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 09/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 W MAIN ST
WEST JEFFERSON OH
43162-1298
US

IV. Provider business mailing address

4823 CHERRY HILL CT S APT 1
COLUMBUS OH
43228-2781
US

V. Phone/Fax

Practice location:
  • Phone: 614-878-7661
  • Fax:
Mailing address:
  • Phone: 614-204-0398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number02730
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: