Provider Demographics
NPI:1124738828
Name:GALUSHA, MCKENSIE (DPT, PT)
Entity type:Individual
Prefix:
First Name:MCKENSIE
Middle Name:
Last Name:GALUSHA
Suffix:
Gender:F
Credentials:DPT, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CARRIAGE CT
Mailing Address - Street 2:
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4010
Mailing Address - Country:US
Mailing Address - Phone:585-775-9928
Mailing Address - Fax:
Practice Address - Street 1:6 CARRIAGE CT
Practice Address - Street 2:
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4010
Practice Address - Country:US
Practice Address - Phone:585-775-9928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303279261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation