Provider Demographics
NPI:1770918823
Name:KML PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:KML PHYSICAL THERAPY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:516-567-7632
Mailing Address - Street 1:57 ELM AVE.
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11001
Mailing Address - Country:US
Mailing Address - Phone:516-567-7632
Mailing Address - Fax:
Practice Address - Street 1:57 ELM AVE
Practice Address - Street 2:NASSAU COUNTY. EARLY INTERVENTION
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11001
Practice Address - Country:US
Practice Address - Phone:516-567-7632
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY10178-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty