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General NPI Number Information
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NPI Number | 1073505087
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Entity Type | Individual
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Provider Name | KENNETH DAVID RESCOTT P.T.
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 37 W GARDEN ST SUITE 103
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City | AUBURN
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State | NY
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Zip | 13021-2662
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Country | US
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Telephone | 315-252-8112
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Fax |
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Provider Business Mailing Address
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Address Line | 37 W GARDEN ST SUITE 103
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City | AUBURN
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State | NY
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Zip | 13021-2662
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Country | US
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Telephone | 315-252-8112
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 010567
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License Number State | NY
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