Provider Demographics
NPI:1447220140
Name:BOULEY, MARY JANE (PT)
Entity Type:Individual
Prefix:
First Name:MARY JANE
Middle Name:
Last Name:BOULEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 N UNION STREET
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559
Mailing Address - Country:US
Mailing Address - Phone:585-349-2860
Mailing Address - Fax:585-349-2995
Practice Address - Street 1:37 N UNION STREET
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559
Practice Address - Country:US
Practice Address - Phone:585-349-2860
Practice Address - Fax:585-349-2995
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016481225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010016481OtherBLUE CHOICE
NY103351FTOtherPREFERRED CARE
NY7024316OtherAETNA
NYP011016481OtherBLUE CROSS BLUE SHIELD