Provider Demographics
NPI:1922729409
Name:GARCIA, CHANELLE (DPT)
Entity Type:Individual
Prefix:
First Name:CHANELLE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 W UTICA ST APT 3
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-2081
Mailing Address - Country:US
Mailing Address - Phone:716-400-1097
Mailing Address - Fax:
Practice Address - Street 1:2099 GRAND ISLAND BLVD STE B
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NY
Practice Address - Zip Code:14072-2266
Practice Address - Country:US
Practice Address - Phone:716-773-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-05
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0493692251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY049369OtherPHYSICAL THERAPY LICENSE