Provider Demographics
NPI:1366492423
Name:KULP, DOUGLAS LLOYD (PT)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:LLOYD
Last Name:KULP
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 NORTHWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14612-3050
Mailing Address - Country:US
Mailing Address - Phone:585-723-9308
Mailing Address - Fax:
Practice Address - Street 1:1331 EAST VICTOR ROAD
Practice Address - Street 2:KULP PHYSICAL THERAPY
Practice Address - City:VICTOR
Practice Address - State:NY
Practice Address - Zip Code:14564-9395
Practice Address - Country:US
Practice Address - Phone:585-742-8270
Practice Address - Fax:585-742-8272
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0089851225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1912659OtherUHC
5351314OtherAETNA
100285ETOtherPREFERRED CARE
RA1098Medicare ID - Type Unspecified
5351314OtherAETNA