Provider Demographics
NPI:1033647276
Name:KILKENNY, SEAN (PTA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:KILKENNY
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MARK LN
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-6733
Mailing Address - Country:US
Mailing Address - Phone:845-598-3652
Mailing Address - Fax:
Practice Address - Street 1:490 ROUTE 304
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3040
Practice Address - Country:US
Practice Address - Phone:845-507-0477
Practice Address - Fax:845-507-0490
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010095-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant