Healthcare Provider Details

I. General information

NPI: 1538169719
Provider Name (Legal Business Name): KENNETH R. KURTZ P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 08/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8705 SHERIDAN DR
WILLIAMSVILLE NY
14221-6317
US

IV. Provider business mailing address

8705 SHERIDAN DR
WILLIAMSVILLE NY
14221-6317
US

V. Phone/Fax

Practice location:
  • Phone: 716-631-1212
  • Fax: 716-631-1363
Mailing address:
  • Phone: 716-631-1212
  • Fax: 716-631-1363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number006171-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: