Provider Demographics
NPI:1619107612
Name:SULKEY, KEVIN L (BS, PTA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:SULKEY
Suffix:
Gender:M
Credentials:BS, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 MADISON AVE
Mailing Address - Street 2:# 1
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3809
Mailing Address - Country:US
Mailing Address - Phone:518-443-2279
Mailing Address - Fax:
Practice Address - Street 1:747 MADISON AVE
Practice Address - Street 2:# 1
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3809
Practice Address - Country:US
Practice Address - Phone:518-443-2279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003246-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant