Individual
ALEXIS BERTOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
149 N MAIN ST, FAIRPORT, NY 14450-1434
(585) 377-2230
Mailing address
149 N MAIN ST, FAIRPORT, NY 14450-1434
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
17
SPECIAL EDUCATOR
—
Enumeration date
03/17/2015
Last updated
01/30/2020
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