Provider Demographics
NPI:1033197710
Name:FEBOS, KATHLEEN K (PT)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:K
Last Name:FEBOS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MONTAUK HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4429
Mailing Address - Country:US
Mailing Address - Phone:631-661-3700
Mailing Address - Fax:631-661-3749
Practice Address - Street 1:400 MONTAUK HWY
Practice Address - Street 2:SUITE# 103
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4429
Practice Address - Country:US
Practice Address - Phone:631-661-3700
Practice Address - Fax:631-661-3749
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7484225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQC6461Medicare Oscar/Certification
NYQC6461Medicare PIN