Provider Demographics
NPI:1902430754
Name:KENETIC PHYSICAL THERAPY PC
Entity Type:Organization
Organization Name:KENETIC PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIEKE
Authorized Official - Middle Name:
Authorized Official - Last Name:KE
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:646-420-8374
Mailing Address - Street 1:21955 74TH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3031
Mailing Address - Country:US
Mailing Address - Phone:646-420-8374
Mailing Address - Fax:
Practice Address - Street 1:21955 74TH AVE FL 2
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3031
Practice Address - Country:US
Practice Address - Phone:646-420-8374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty