Provider Demographics
NPI:1902130651
Name:KRESS, KEVIN M (PT)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:KRESS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:HERKIMER
Mailing Address - State:NY
Mailing Address - Zip Code:13350-1041
Mailing Address - Country:US
Mailing Address - Phone:315-717-0020
Mailing Address - Fax:315-717-0024
Practice Address - Street 1:3061 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-1041
Practice Address - Country:US
Practice Address - Phone:315-717-0020
Practice Address - Fax:315-717-0024
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY031915225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400006732Medicare PIN