Healthcare Provider Details

I. General information

NPI: 1629017579
Provider Name (Legal Business Name): KINETIC PHYSICAL THERAPY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 LAKE ST
RAMSEY NJ
07446-2089
US

IV. Provider business mailing address

171 LAKE ST
RAMSEY NJ
07446-2089
US

V. Phone/Fax

Practice location:
  • Phone: 201-327-1990
  • Fax: 201-327-1921
Mailing address:
  • Phone: 201-327-1990
  • Fax: 201-327-1921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. EVAN M CHAIT
Title or Position: OWNER
Credential: P.T.
Phone: 201-327-1990