Basic Information
| Provider Information | |||||||||
| NPI: | 1184272650 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRINTUP | ||||||||
| FirstName: | KEVIN | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5823 WIDEWATERS PKWY STE 3 | ||||||||
| Address2: | |||||||||
| City: | EAST SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130573081 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154184013 | ||||||||
| FaxNumber: | 3154780388 | ||||||||
| Practice Location | |||||||||
| Address1: | 5496 E TAFT RD STE 2B | ||||||||
| Address2: | |||||||||
| City: | NORTH SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 132123773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154184042 | ||||||||
| FaxNumber: | 3154586905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2019 | ||||||||
| LastUpdateDate: | 08/28/2019 | ||||||||
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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 | 044719 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.