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General NPI Number Information
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NPI Number | 1063307510
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Entity Type | Individual
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Provider Name | SCOTT KOENNECKE
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Gender | Male
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Dates
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Enumeration Date | 06/12/2025
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Last Update Date | 06/12/2025
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Provider Practice Location Address
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Address Line | 8 TWIN SPRING LN
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City | FLORIDA
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State | NY
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Zip | 10921-1033
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Country | US
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Telephone | 845-344-7281
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Fax |
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Provider Business Mailing Address
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Address Line | 8 TWIN SPRING LN
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City | FLORIDA
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State | NY
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Zip | 10921-1033
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251G0304X
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Taxonomy Name | Geriatric Physical Therapist
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License Number |
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License Number State |
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