Provider Demographics
NPI:1851014849
Name:FALCO, DONELLE TERESA (LMT)
Entity Type:Individual
Prefix:
First Name:DONELLE
Middle Name:TERESA
Last Name:FALCO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 DECATUR ST # 101
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-1907
Mailing Address - Country:US
Mailing Address - Phone:315-955-5797
Mailing Address - Fax:
Practice Address - Street 1:989 KENMORE AVE
Practice Address - Street 2:
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-2924
Practice Address - Country:US
Practice Address - Phone:716-335-9711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031211-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist