MEDICARE: KERRY THELUSMOND PT,DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251X0800X	Orthopedic Physical Therapist	052792	NY

General Provider Information

NPI Number	:	1538980966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY THELUSMOND PT,DPT

Provider Business Mailing Address
First Line	:	31 HUDSON YARDS FL 10
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-2170
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 HUDSON YARDS FL 10
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-2170
Country	:	US
Telephone Number	:	646-422-5960
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2024
Last Update Date	:	10/18/2024

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