MEDICARE: KENEFICK PHYSICAL THERAPY PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1003430018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENEFICK PHYSICAL THERAPY PLLC

Provider Business Mailing Address
First Line	:	112 NOEL AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-6421
Country	:	US
Telephone Number	:	917-755-9172
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 NOEL AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-6421
Country	:	US
Telephone Number	:	917-755-9172
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEVIN GERARD KENEFICK
Credential	:	PT, DPT, CMPT, MS
Telephone Number	:	917-755-9172

Provider Enumeration Date	:	06/05/2020
Last Update Date	:	06/05/2020

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