MEDICARE: KELSEY FITZGERALD D.P.T.

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	225100000X	Physical Therapist	040475	NY

General Provider Information

NPI Number	:	1952753584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEY FITZGERALD D.P.T.

Provider Business Mailing Address
First Line	:	777 MARYVALE DR
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14225-2712
Country	:	US
Telephone Number	:	716-833-8603
Fax Number	:

Provider Business Practice Location Address
First Line	:	777 MARYVALE DR
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14225-2712
Country	:	US
Telephone Number	:	716-833-8603
Fax Number	:

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

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	09/07/2016

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