Healthcare Provider Details

I. General information

NPI: 1740897008
Provider Name (Legal Business Name): KYNASTON SCHULTZ PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 WHITE PLAINS RD
TARRYTOWN NY
10591-5523
US

IV. Provider business mailing address

307 5TH AVE FL 6
NEW YORK NY
10016-6575
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-3535
  • Fax: 212-342-1470
Mailing address:
  • Phone: 212-759-2282
  • Fax: 212-379-2123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number046313
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number046313
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: