Provider Demographics
NPI:1861771651
Name:KAMINSKY, NOAH LUCIAN (DPT, CSCS)
Entity type:Individual
Prefix:
First Name:NOAH
Middle Name:LUCIAN
Last Name:KAMINSKY
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 N CHURCH ST
Mailing Address - Street 2:STE D
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27405-5666
Mailing Address - Country:US
Mailing Address - Phone:336-274-7480
Mailing Address - Fax:336-274-8903
Practice Address - Street 1:6500 CREEDMOOR RD
Practice Address - Street 2:STE 28
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27613-3697
Practice Address - Country:US
Practice Address - Phone:919-676-2001
Practice Address - Fax:919-676-0023
Is Sole Proprietor?:No
Enumeration Date:2011-08-10
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033895225100000X
NCP15281225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400054061Medicare PIN