Healthcare Provider Details

I. General information

NPI: 1932914587
Provider Name (Legal Business Name): KEVIN O OKONTA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 BREELEY BLVD # 1013
MELVILLE NY
11747-5332
US

IV. Provider business mailing address

125 BREELEY BLVD
MELVILLE NY
11747-5332
US

V. Phone/Fax

Practice location:
  • Phone: 631-940-3288
  • Fax:
Mailing address:
  • Phone: 631-599-3411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number053795
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: