Healthcare Provider Details

I. General information

NPI: 1639781867
Provider Name (Legal Business Name): KELLY WEBSTER DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9822 NY-16
MACHIAS NY
14101
US

IV. Provider business mailing address

62 BEYER PL
BUFFALO NY
14210-2654
US

V. Phone/Fax

Practice location:
  • Phone: 716-353-8516
  • Fax:
Mailing address:
  • Phone: 716-948-0160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number0469300N
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: