Healthcare Provider Details

I. General information

NPI: 1477109221
Provider Name (Legal Business Name): KYLE DINICOLA ORT/L, PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 E 32ND ST FL 4
NEW YORK NY
10016-5595
US

IV. Provider business mailing address

31 E 32ND ST FL 4
NEW YORK NY
10016-5595
US

V. Phone/Fax

Practice location:
  • Phone: 212-759-2282
  • Fax:
Mailing address:
  • Phone: 212-759-2282
  • Fax: 212-379-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number6648
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number001833
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: