Provider Demographics
NPI:1275873002
Name:KELLERHOUSE, MEGAN LESPERENCE (DPT)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LESPERENCE
Last Name:KELLERHOUSE
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 1:1 FOXCARE DR
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2099
Mailing Address - Country:US
Mailing Address - Phone:607-431-5702
Mailing Address - Fax:607-431-5709
Practice Address - Street 1:1 FOXCARE DR
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2099
Practice Address - Country:US
Practice Address - Phone:607-431-5702
Practice Address - Fax:607-431-5709
Is Sole Proprietor?:No
Enumeration Date:2013-02-14
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00279098Medicaid
NY330085OtherFACILITY MEDICARE