Provider Demographics
NPI:1730463134
Name:SHELLY KRAETZ
Entity Type:Organization
Organization Name:SHELLY KRAETZ
Other - Org Name:FYZICAL THERAPY & BALANCE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:G
Authorized Official - Last Name:KRAETZ
Authorized Official - Suffix:
Authorized Official - Credentials:PDT, CLT
Authorized Official - Phone:315-291-7042
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225100000X
NY029599-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty