Provider Demographics
NPI:1003832692
Name:KINGSLEY-HYLKEMA PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:KINGSLEY-HYLKEMA PHYSICAL THERAPY, P.C.
Other - Org Name:DYNAMIC PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:JOHANNA SJOERDJE
Authorized Official - Last Name:HYLKEMA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:845-876-8220
Mailing Address - Street 1:3752 ROUTE 9G
Mailing Address - Street 2:
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1173
Mailing Address - Country:US
Mailing Address - Phone:845-876-8220
Mailing Address - Fax:845-876-8221
Practice Address - Street 1:3752 ROUTE 9G
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1173
Practice Address - Country:US
Practice Address - Phone:845-876-8220
Practice Address - Fax:845-876-8221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015726-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYKI0Q0WSI10OtherMEDICARE EMC GROUP
NYQL6862OtherMEDICARE THOMAS KINGSLEY
NYQL6872OtherMEDICARE INGRID HYLKEMA
NY1639184542OtherINGRID HYLKEMA NPI#
NY1720094881OtherTHOMAS KINGSLEY NPI#
NYIH0QL68720OtherMEDICARE I.HYLKEMA EMC
NYTK0QL68620OtherMEDICARE T.KINGSLEY EMC
NYQL686Q0SI1OtherMEDICARE T.KINGSLEY PAPER
NYQL687Q0SI1OtherMEDICARE I.HYLKEMA PAPER
NYQL6872OtherMEDICARE INGRID HYLKEMA