=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952061624
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BIOKINESIS HEALTH AND PERFORMANCE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/22/2021
-----------------------------------------------------
Last Update Date | 12/22/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 614 OTTER BRANCH DR
-----------------------------------------------------
City | MAGNOLIA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08049-1121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-634-5607
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 614 OTTER BRANCH DR
-----------------------------------------------------
City | MAGNOLIA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08049-1121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-634-5607
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICAL THERAPIST
-----------------------------------------------------
Name | DR. STEVEN DENNIS KREH JR.
-----------------------------------------------------
Credential | DPT
-----------------------------------------------------
Telephone | 609-634-5607
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------