Provider Demographics
NPI:1255970299
Name:ROSS, KATHLEEN MARY (DPT)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MARY
Last Name:ROSS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:M
Other - Last Name:ENGELHARDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:15 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14222-1124
Mailing Address - Country:US
Mailing Address - Phone:716-310-5773
Mailing Address - Fax:
Practice Address - Street 1:1250 NIAGARA ST FL 2
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14213-1502
Practice Address - Country:US
Practice Address - Phone:716-310-5773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-21
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0430202251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic