Basic Information
| Provider Information | |||||||||
| NPI: | 1053973537 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIANCONI | ||||||||
| FirstName: | KURTIS | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | PT DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 STATE ROUTE 34B | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130269729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3152836155 | ||||||||
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| Practice Location | |||||||||
| Address1: | 230 TRIPHAMMER RD | ||||||||
| Address2: | |||||||||
| City: | ITHACA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148502517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6072665300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2019 | ||||||||
| LastUpdateDate: | 07/03/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 044445 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.