Provider Demographics
NPI:1245014885
Name:KEHOE, NICHOLAS (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:
Last Name:KEHOE
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 PROSPECT AVE APT B
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14201-1139
Mailing Address - Country:US
Mailing Address - Phone:315-398-0771
Mailing Address - Fax:
Practice Address - Street 1:8637 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7501
Practice Address - Country:US
Practice Address - Phone:716-503-2322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050798225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist