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General NPI Number Information
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NPI Number | 1659930287
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Entity Type | Organization
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Legal Business Name | KINETIX PHYSICAL THERAPY PC
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Dates
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Enumeration Date | 06/07/2019
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Last Update Date | 11/07/2024
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Provider Practice Location Address
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Address Line | 1751 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3513
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Country | US
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Telephone | 718-252-0625
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Fax | 718-252-0615
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Provider Business Mailing Address
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Address Line | 1751 VICTORY BLVD
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City | STATEN ISLAND
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State | NY
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Zip | 10314-3513
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Country | US
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Telephone | 718-252-0625
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Fax | 718-252-0615
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD MELVILLE
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Credential | DPT
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Telephone | 347-728-5499
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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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