Healthcare Provider Details

I. General information

NPI: 1275508459
Provider Name (Legal Business Name): KELLI HURSH DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3313 CHILI AVE
ROCHESTER NY
14624-5300
US

IV. Provider business mailing address

92 WEST AVE
BROCKPORT NY
14420-1306
US

V. Phone/Fax

Practice location:
  • Phone: 585-889-7777
  • Fax: 585-889-8282
Mailing address:
  • Phone: 585-637-0790
  • Fax: 585-637-3572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number025750
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: