Healthcare Provider Details

I. General information

NPI: 1013675115
Provider Name (Legal Business Name): KIN PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2021
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 HARRISON AVE STE 307
BOSTON MA
02111-1924
US

IV. Provider business mailing address

65 HARRISON AVE STE 307
BOSTON MA
02111-1924
US

V. Phone/Fax

Practice location:
  • Phone: 617-866-2899
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIN S WONG
Title or Position: OWNER
Credential: PT
Phone: 617-866-2899