MEDICARE: KENNETH LI DPT

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	048176	NY

General Provider Information

NPI Number	:	1760139109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH LI DPT

Provider Business Mailing Address
First Line	:	9718 FORT HAMILTON PKWY APT 2D
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11209-8134
Country	:	US
Telephone Number	:	347-585-3804
Fax Number	:

Provider Business Practice Location Address
First Line	:	3099 EMMONS AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-1709
Country	:	US
Telephone Number	:	718-395-7445
Fax Number	:

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

Provider Enumeration Date	:	03/06/2022
Last Update Date	:	03/06/2022

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Directions to “ KENNETH LI DPT” Practice Location

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