Provider Demographics
NPI:1669594396
Name:HUMMEL, KELLIE E (PT)
Entity type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:E
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 N TAYLOR PL
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-2044
Mailing Address - Country:US
Mailing Address - Phone:607-227-1410
Mailing Address - Fax:
Practice Address - Street 1:540 N TAYLOR PL
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-2044
Practice Address - Country:US
Practice Address - Phone:607-227-1410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2013-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022125-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist