Provider Demographics
NPI:1689955130
Name:FELLOWS, JULIE (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:FELLOWS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:ROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:462 GRIDER STREET
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215
Mailing Address - Country:US
Mailing Address - Phone:716-898-3895
Mailing Address - Fax:813-633-9890
Practice Address - Street 1:462 GRIDER STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14215
Practice Address - Country:US
Practice Address - Phone:716-898-3895
Practice Address - Fax:813-633-9890
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 26762225100000X
NY033967225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist