Healthcare Provider Details

I. General information

NPI: 1912217050
Provider Name (Legal Business Name): TRACEY ANN KELEHER P.T
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2010
Last Update Date: 10/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 INDEPENDENCE LN
GRAND ISLAND NY
14072-1877
US

IV. Provider business mailing address

150 INDEPENDENCE LN
GRAND ISLAND NY
14072-1877
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number015207-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: