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General NPI Number Information
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NPI Number | 1376113605
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Entity Type | Individual
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Provider Name | KILEY AUSTIN PT, DPT, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 1091 MAIN ST UNIT 120
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City | BUFFALO
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State | NY
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Zip | 14209-2305
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Country | US
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Telephone | 716-282-2888
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Fax |
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Provider Business Mailing Address
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Address Line | 38 PONDEROSA CT
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City | ORCHARD PARK
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State | NY
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Zip | 14127-2070
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Country | US
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Telephone | 716-410-2720
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 052748-01
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License Number State | NY
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