Provider Demographics
NPI:1619422086
Name:BUHL, LOUIE ANN
Entity Type:Individual
Prefix:
First Name:LOUIE ANN
Middle Name:
Last Name:BUHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOUIE ANN
Other - Middle Name:
Other - Last Name:ICAWALO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23 CLERMONT ST UNIT A
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-2204
Mailing Address - Country:US
Mailing Address - Phone:917-530-7942
Mailing Address - Fax:
Practice Address - Street 1:673 COLUMBIA TPKE
Practice Address - Street 2:
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-2130
Practice Address - Country:US
Practice Address - Phone:518-233-0544
Practice Address - Fax:518-233-0703
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2019-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1241738225100000X
NJ40QA01665100225100000X
NY036670225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist