Provider Demographics
NPI:1508106386
Name:BUFFA, KELLY LYNN (PT)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNN
Last Name:BUFFA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KEYYY
Other - Middle Name:LYNN
Other - Last Name:SNIZEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2209 GENESEE ST
Mailing Address - Street 2:BUSINESS OFFICE ROOM 315
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-5930
Mailing Address - Country:US
Mailing Address - Phone:315-798-8361
Mailing Address - Fax:315-798-8397
Practice Address - Street 1:2209 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-5930
Practice Address - Country:US
Practice Address - Phone:315-798-8361
Practice Address - Fax:315-798-8397
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist