Provider Demographics
NPI:1902996051
Name:MANDELL, JOLIE (PT)
Entity Type:Individual
Prefix:
First Name:JOLIE
Middle Name:
Last Name:MANDELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:JOLIE
Other - Middle Name:
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:8746 ERIE RD
Mailing Address - Street 2:# A
Mailing Address - City:ANGOLA
Mailing Address - State:NY
Mailing Address - Zip Code:14006-9620
Mailing Address - Country:US
Mailing Address - Phone:716-883-0515
Mailing Address - Fax:716-883-8764
Practice Address - Street 1:656 ELMWOOD AVE.
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222
Practice Address - Country:US
Practice Address - Phone:716-883-0515
Practice Address - Fax:716-883-8764
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8129225100000X
NY0210331225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist