Healthcare Provider Details

I. General information

NPI: 1093443780
Provider Name (Legal Business Name): SCOTT KOENNECKE PHYSICAL THERAPY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 TWIN SPRING LN
FLORIDA NY
10921-1033
US

IV. Provider business mailing address

8 TWIN SPRING LN
FLORIDA NY
10921-1033
US

V. Phone/Fax

Practice location:
  • Phone: 845-344-7281
  • Fax: 845-651-1215
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 Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name: SCOTT KOENNECKE
Title or Position: PRESIDENT
Credential: PT
Phone: 845-344-7281