Provider Demographics
NPI:1538169719
Name:KURTZ, KENNETH R (PT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:R
Last Name:KURTZ
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 1:8705 SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6317
Mailing Address - Country:US
Mailing Address - Phone:716-631-1212
Mailing Address - Fax:716-631-1363
Practice Address - Street 1:8705 SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6317
Practice Address - Country:US
Practice Address - Phone:716-631-1212
Practice Address - Fax:716-631-1363
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006171-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYUHC RAILROAD MEDICAROther650003262
NY00020519501OtherUNIVERA
NY125381OtherMANAGED PHYSICAL NETWORK
NY01557051Medicaid
NY000608163001OtherBLUE CROSS & BLUE SHIELD
NY69931OtherGHI
NY125381OtherMANAGED PHYSICAL NETWORK