MEDICARE: KATHLEEN ANNE VIOLA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist
2	225100000X	Physical Therapist	008631-1	NY

General Provider Information

NPI Number	:	1013423656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN ANNE VIOLA PT

Provider Business Mailing Address
First Line	:	45 W 67TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-6257
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 W 67TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10023-6257
Country	:	US
Telephone Number	:	212-842-0080
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2017
Last Update Date	:	12/19/2017

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