Provider Demographics
NPI:1598530057
Name:KAMBERALIS, COURTNEY LEE (DPT)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:LEE
Last Name:KAMBERALIS
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 1:1325 DEER LAKES DR APT 1325
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-5423
Mailing Address - Country:US
Mailing Address - Phone:603-702-2994
Mailing Address - Fax:
Practice Address - Street 1:635 CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:GETZVILLE
Practice Address - State:NY
Practice Address - Zip Code:14068-1003
Practice Address - Country:US
Practice Address - Phone:603-702-2994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-15
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2519554225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist