Provider Demographics
NPI:1164978946
Name:BRUNSCHEEN, KELLY ANN (DPT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:BRUNSCHEEN
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 1:274 TOMPKINS ST
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-3455
Mailing Address - Country:US
Mailing Address - Phone:607-756-9886
Mailing Address - Fax:607-756-8939
Practice Address - Street 1:274 TOMPKINS ST
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-3455
Practice Address - Country:US
Practice Address - Phone:607-756-9886
Practice Address - Fax:607-756-8939
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039195-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist