Provider Demographics
NPI:1194306308
Name:BUERGE, KELLSEY ANN (DPT)
Entity type:Individual
Prefix:
First Name:KELLSEY
Middle Name:ANN
Last Name:BUERGE
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:SECO PHYSICAL THERAPY 26 CONKEY AVE
Mailing Address - Street 2:5TH FLOOR SUITE 136
Mailing Address - City:NORWICH
Mailing Address - State:NY
Mailing Address - Zip Code:13815
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MARGARETVILLE HOSPITAL 42084 ROUTE 28
Practice Address - Street 2:
Practice Address - City:MARGARETVILLE
Practice Address - State:NY
Practice Address - Zip Code:12455
Practice Address - Country:US
Practice Address - Phone:845-586-2631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047000208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation