Healthcare Provider Details

I. General information

NPI: 1649124207
Provider Name (Legal Business Name): KISHEL PHYSICAL THERAPY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 03/07/2026
Certification Date: 03/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

854 OLEAN RD
EAST AURORA NY
14052-9782
US

IV. Provider business mailing address

854 OLEAN RD
EAST AURORA NY
14052-9782
US

V. Phone/Fax

Practice location:
  • Phone: 716-481-5945
  • Fax:
Mailing address:
  • Phone: 716-481-5945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SEAN MATTHEW KISHEL
Title or Position: OWNER
Credential: DPT
Phone: 716-481-5945