Provider Demographics
NPI:1972731438
Name:GREVE, KELLY R (MPT)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:R
Last Name:GREVE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:R
Other - Last Name:ALTENBURGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:119 VALLEY AVE
Mailing Address - Street 2:
Mailing Address - City:LOCUST VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11560-2040
Mailing Address - Country:US
Mailing Address - Phone:516-801-0113
Mailing Address - Fax:951-848-9050
Practice Address - Street 1:119 VALLEY AVE
Practice Address - Street 2:
Practice Address - City:LOCUST VALLEY
Practice Address - State:NY
Practice Address - Zip Code:11560-2040
Practice Address - Country:US
Practice Address - Phone:516-801-0113
Practice Address - Fax:951-848-9050
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031091-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist