MEDICARE: KRISTEN GAUCK

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	208100000X	Physical Medicine & Rehabilitation Physician	024823	NY
2	225100000X	Physical Therapist	024823-1	NY

General Provider Information

NPI Number	:	1760514970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN GAUCK

Provider Business Mailing Address
First Line	:	1000 ELMWOOD AVE STE 100
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-3042
Country	:	US
Telephone Number	:	585-271-0761
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 ELMWOOD AVE STE 100
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14620-3093
Country	:	US
Telephone Number	:	585-271-0761
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	12/02/2022

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Directions to “ KRISTEN GAUCK ” Practice Location

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