Healthcare Provider Details

I. General information

NPI: 1760116982
Provider Name (Legal Business Name): ANN MARIE BUELL I PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 07/13/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 W MAIN ST
MONROE WA
98272-2022
US

IV. Provider business mailing address

7990 200TH ST NE APT 97
ARLINGTON WA
98223-4000
US

V. Phone/Fax

Practice location:
  • Phone: 360-794-4011
  • Fax:
Mailing address:
  • Phone: 425-330-5075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberP160043772
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: