Provider Demographics
NPI:1265048573
Name:DUXBURY, JENELL NICOLE (PT, DPT)
Entity type:Individual
Prefix:
First Name:JENELL
Middle Name:NICOLE
Last Name:DUXBURY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3164 LOVE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:14072-2430
Mailing Address - Country:US
Mailing Address - Phone:716-239-0555
Mailing Address - Fax:
Practice Address - Street 1:2111 SAWYER DR
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2975
Practice Address - Country:US
Practice Address - Phone:716-731-2195
Practice Address - Fax:716-731-4862
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046367225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist