MEDICARE: KINESIOWORKS PHYSICAL THERAPY, P.C.

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487110888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINESIOWORKS PHYSICAL THERAPY, P.C.

Provider Business Mailing Address
First Line	:	38 DEERFIELD ST
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-1805
Country	:	US
Telephone Number	:	201-968-6112
Fax Number	:	201-561-0158

Provider Business Practice Location Address
First Line	:	1980 AMSTERDAM AVE # 1B
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-5058
Country	:	US
Telephone Number	:	212-740-2049
Fax Number	:	917-388-3417

Authorized Official
Title or Position	:	DOCTOR OF PHYSICAL THERAPY
Name	:	DR. HAZEL MARUCUT STO TOMAS
Credential	:	PT, DPT
Telephone Number	:	718-839-3046

Provider Enumeration Date	:	02/11/2019
Last Update Date	:	02/18/2021

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