Healthcare Provider Details

I. General information

NPI: 1649797820
Provider Name (Legal Business Name): KAIZEN PHYSICAL THERAPY P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 COOPER RD APT 715
POUGHKEEPSIE NY
12603
US

IV. Provider business mailing address

26 COOPER RD APT 715
POUGHKEEPSIE NY
12603-1670
US

V. Phone/Fax

Practice location:
  • Phone: 845-541-2230
  • Fax:
Mailing address:
  • Phone: 845-541-2230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BONIFACIO WENCESLAO JR.
Title or Position: OWNER
Credential: PT
Phone: 845-541-2230