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General NPI Number Information
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NPI Number | 1245861640
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Entity Type | Organization
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Legal Business Name | KINETIQUE PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 02/04/2020
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Last Update Date | 04/08/2020
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Provider Practice Location Address
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Address Line | 2025 BRENTWOOD RD
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City | BRENTWOOD
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State | NY
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Zip | 11717-4656
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Country | US
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Telephone | 631-234-4949
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Fax |
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Provider Business Mailing Address
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Address Line | 2025 BRENTWOOD RD
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City | BRENTWOOD
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State | NY
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Zip | 11717-4656
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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 | PHYSICAL THERAPIST
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Name | LARISSA FRANCISCO
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Credential |
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Telephone | 516-562-1841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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