Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 034523 | NY |
N | 2251S0007X | Physical Therapist - Sports | 034523 | NY |
N | 2251X0800X | Physical Therapist - Orthopedic | 034523 | NY |
NPI | 1407124639 |
---|---|
Provider Name | Dr. Alyssa Christine Kurtzner-Shute |
First Address | Chittenango, NY 13037 |
Second Address | Chittenango, NY 13037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/12/2011 |
Last Update Date | 18/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12306237 | C AQH (01) | NY |
1407124639 | INDIVIDUAL NPI (01) | NY |
1477782589 | (02) | NY |