Provider Demographics
NPI:1619630894
Name:KOROL, MADELYN CATHERINE
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:CATHERINE
Last Name:KOROL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6534 ANTHONY DR STE C
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1421
Mailing Address - Country:US
Mailing Address - Phone:585-869-5140
Mailing Address - Fax:
Practice Address - Street 1:6534 ANTHONY DR STE C
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-1421
Practice Address - Country:US
Practice Address - Phone:585-869-5140
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-14
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist