Provider Demographics
NPI:1053973537
Name:BIANCONI, KURTIS JAMES (PT DPT)
Entity type:Individual
Prefix:
First Name:KURTIS
Middle Name:JAMES
Last Name:BIANCONI
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 STATE ROUTE 34B
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:13026-9729
Mailing Address - Country:US
Mailing Address - Phone:315-283-6155
Mailing Address - Fax:
Practice Address - Street 1:230 TRIPHAMMER RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-2517
Practice Address - Country:US
Practice Address - Phone:607-266-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044445225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist