Individual
MERLE CORTELLUCCI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., ATC
Contact information
Practice address
4225 GENESEE ST, BUFFALO, NY 14225-1994
(716) 829-6123
Mailing address
4225 GENESEE ST, CHEEKTOWAGA, NY 14225-1994
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
001767
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1009128
NATA
—
01
—
2000000180
BOC
—
Enumeration date
08/12/2020
Last updated
08/12/2020
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