Provider Demographics
NPI:1619169455
Name:KRAETZ, SHELLY G (DPT)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:G
Last Name:KRAETZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:MRS
Other - First Name:SHELLY
Other - Middle Name:G
Other - Last Name:PESARCHICK
Other - Suffix:III
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 611
Mailing Address - Street 2:
Mailing Address - City:SKANEATELES
Mailing Address - State:NY
Mailing Address - Zip Code:13152-0611
Mailing Address - Country:US
Mailing Address - Phone:315-291-7042
Mailing Address - Fax:315-291-7048
Practice Address - Street 1:810 W GENESEE STREET RD
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152
Practice Address - Country:US
Practice Address - Phone:315-291-7042
Practice Address - Fax:315-291-7048
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029599-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty