Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Kevin J Nellis, PT

Individual provider Specialist · NPI 1790867547

Kevin J Nellis, PT is a Physical Therapist in Private Practice in Syracuse, New York. Qualified in 1983, 43 years ago. Practices with Peterson and Nellis Physical Therapy PC, a 5-clinician group and accepts Medicare assignment. Licensed in New York.

Years since qualifying
43
Licensed in
NY
In the registry since
2006
Specialties on file
2
What do these letters mean?
PT — Physical Therapist
A licensed therapist who treats movement, pain and injury.

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Practice location Address checks out

207 Pine St
Syracuse, NY 13210-1137
Phone: (315) 476-3175
Fax: (315) 476-0170
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physical Therapist (primary) Taxonomy 225100000X
Specialist Taxonomy 174400000X · Licence 8133 (NY)

Record details

NPI number1790867547
Entity typeIndividual (Type 1)
GenderMale
Credentials PT
Sole proprietorNo
NPI enumeratedOctober 20, 2006
Last updated in NPPESFebruary 9, 2011

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 1983 (43 years in practice)
Group practice Peterson And Nellis Physical Therapy Pc — 5 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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