Provider Demographics
NPI:1376720334
Name:KIMA PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:KIMA PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:VINCEL
Authorized Official - Suffix:
Authorized Official - Credentials:PT, MPHTY
Authorized Official - Phone:212-686-3107
Mailing Address - Street 1:14 W 23RD ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5203
Mailing Address - Country:US
Mailing Address - Phone:212-686-3101
Mailing Address - Fax:212-686-3101
Practice Address - Street 1:14 W 23RD ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5203
Practice Address - Country:US
Practice Address - Phone:212-686-3101
Practice Address - Fax:212-686-3101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019132-1261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ23Y11Medicare PIN