Provider Demographics
NPI:1083172670
Name:HILL, KEVIN D (LMT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:D
Last Name:HILL
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 CASSANDRA CIR
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14428-9776
Mailing Address - Country:US
Mailing Address - Phone:585-356-9757
Mailing Address - Fax:
Practice Address - Street 1:4332 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:NORTH CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514-1260
Practice Address - Country:US
Practice Address - Phone:585-594-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019893225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist