Provider Demographics
NPI:1003430018
Name:KENEFICK PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:KENEFICK PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GERARD
Authorized Official - Last Name:KENEFICK
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CMPT, MS
Authorized Official - Phone:917-755-9172
Mailing Address - Street 1:112 NOEL AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-6421
Mailing Address - Country:US
Mailing Address - Phone:917-755-9172
Mailing Address - Fax:
Practice Address - Street 1:112 NOEL AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-6421
Practice Address - Country:US
Practice Address - Phone:917-755-9172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-05
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy