Provider Demographics
NPI:1760116982
Name:BUELL, ANN MARIE I (PTA)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:BUELL
Suffix:I
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7990 200TH ST NE APT 97
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-4000
Mailing Address - Country:US
Mailing Address - Phone:425-330-5075
Mailing Address - Fax:
Practice Address - Street 1:1355 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-2022
Practice Address - Country:US
Practice Address - Phone:360-794-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160043772225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant