Provider Demographics
NPI:1548930688
Name:PICKARD, KELLEY ANN (DPT)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:ANN
Last Name:PICKARD
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2111 SAWYER DR
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14304-2975
Mailing Address - Country:US
Mailing Address - Phone:716-731-2195
Mailing Address - Fax:
Practice Address - Street 1:2111 SAWYER DR
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304-2975
Practice Address - Country:US
Practice Address - Phone:716-731-2195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047552-012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic