Provider Demographics
NPI:1346203288
Name:VROOMAN, KELLY ANN (PT)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:VROOMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 CLIZBE AVE
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-2935
Mailing Address - Country:US
Mailing Address - Phone:518-842-1425
Mailing Address - Fax:518-842-1706
Practice Address - Street 1:178 CLIZBE AVE
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-2935
Practice Address - Country:US
Practice Address - Phone:518-842-1425
Practice Address - Fax:518-842-1706
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0156121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000406408001OtherBLUE SHIELD
Q23741OtherBLUE CROSS
10023183OtherCDPHP
NY01940532Medicaid
43053OtherMVP
Q23741OtherBLUE CROSS
43053OtherMVP