Provider Demographics
NPI:1164944260
Name:FENZEL, PATRICIA ANN (MT)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:FENZEL
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1909 UNION RD
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2013
Mailing Address - Country:US
Mailing Address - Phone:716-675-3380
Mailing Address - Fax:
Practice Address - Street 1:1909 UNION ROAD
Practice Address - Street 2:
Practice Address - City:WEST SENCA
Practice Address - State:NY
Practice Address - Zip Code:14224
Practice Address - Country:US
Practice Address - Phone:716-675-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-10
Last Update Date:2017-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019641225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist