Provider Demographics
NPI:1063587160
Name:SHEEHAN-COMBEST, KELLY ANN (PT)
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:ANN
Last Name:SHEEHAN-COMBEST
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:75 MAINE AVE
Mailing Address - Street 2:D-22
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3650
Mailing Address - Country:US
Mailing Address - Phone:516-867-5050
Mailing Address - Fax:516-867-0868
Practice Address - Street 1:830 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-4098
Practice Address - Country:US
Practice Address - Phone:516-867-5050
Practice Address - Fax:516-867-0868
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017234225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist