Healthcare Provider Details

I. General information

NPI: 1194872002
Provider Name (Legal Business Name): PAUL T KELEHER PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST
BUFFALO NY
14215-3021
US

IV. Provider business mailing address

150 INDEPENDENCE LN
GRAND ISLAND NY
14072-1877
US

V. Phone/Fax

Practice location:
  • Phone: 716-898-3224
  • Fax: 716-898-3259
Mailing address:
  • Phone: 716-773-5986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number018905-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: