Provider Demographics
NPI:1578874582
Name:KEKIS, NICOLE DMITRI (PT)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:DMITRI
Last Name:KEKIS
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 1:130 BROOKLEY RD.
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13441-2530
Mailing Address - Country:US
Mailing Address - Phone:315-533-1150
Mailing Address - Fax:315-533-1173
Practice Address - Street 1:130 BROOKLEY RD.
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13441-2530
Practice Address - Country:US
Practice Address - Phone:315-533-1150
Practice Address - Fax:315-533-1173
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022031-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist