MEDICARE: MR. KENNETH AIDEN LEACOCK P.T.

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	225100000X	Physical Therapist	007365	NY
2	2251X0800X	Orthopedic Physical Therapist	007365	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	007365	OTHER	NY	P.T. LICENCE

General Provider Information

NPI Number	:	1730166398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KENNETH AIDEN LEACOCK P.T.

Provider Business Mailing Address
First Line	:	233 W 139TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030-2104
Country	:	US
Telephone Number	:	212-283-6095
Fax Number	:	212-234-5237

Provider Business Practice Location Address
First Line	:	233 W 139TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10030-2104
Country	:	US
Telephone Number	:	212-283-6095
Fax Number	:	212-283-6095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	09/11/2025

Similar Medicare Providers

1033143003 — DR. CHI CHING SHUM MD
Practice Location Address:

210 E 47TH ST APT 1A
NEW YORK, NY
10017-2104

Practice Phone: 212-308-4894
Practice Fax: 646-585-9194

1013097799 — DR. SIBTAIN RAHIM MD
Practice Location Address:

465 W 23RD ST , APT. 6E
NEW YORK, NY
10011-2104

Practice Phone: 212-245-5362
Practice Fax: 212-245-5362

1881723781 — MS. SUSAN HYATT MA
Practice Location Address:

157 E 57TH ST , PENTHOUSE B
NEW YORK, NY
10022-2104

Practice Phone: 212-838-8309
Practice Fax: 646-827-2248

1548423650 — MS. ELANIA LANIER
Practice Location Address:

15 W 136TH ST FL 2
NEW YORK, NY
10037-2104

Practice Phone: 212-939-8484
Practice Fax: 212-939-3087

1134480163 — MR. PABLO ANTONIO DOMINGUEZ MSED, MBA,BA
Practice Location Address:

521 ISHAM ST , APT 2F
NEW YORK, NY
10034-2104

Practice Phone: 212-567-4989
Practice Fax:

1285996066 — SUSAN SUPER MA, ED.
Practice Location Address:

473 FDR DR APT 2104
NEW YORK, NY
10002-1089

Practice Phone: 212-254-7039
Practice Fax:

Directions to “ MR. KENNETH AIDEN LEACOCK P.T.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.