Provider Demographics
NPI:1275508459
Name:HURSH, KELLI (DPT)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:HURSH
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 1:92 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1306
Mailing Address - Country:US
Mailing Address - Phone:585-637-0790
Mailing Address - Fax:585-637-3572
Practice Address - Street 1:3313 CHILI AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-5300
Practice Address - Country:US
Practice Address - Phone:585-889-7777
Practice Address - Fax:585-889-8282
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
47965337OtherAETNA
NY125745FTOtherPREFERRED CARE
NYRA1467Medicare ID - Type Unspecified