Provider Demographics
NPI:1467909408
Name:CORE KINETICS PHYSICAL THERAPY PLLC
Entity Type:Organization
Organization Name:CORE KINETICS PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:KEATING
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:516-526-5196
Mailing Address - Street 1:28 PIERMONT CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1410
Mailing Address - Country:US
Mailing Address - Phone:516-526-5196
Mailing Address - Fax:631-351-4049
Practice Address - Street 1:177 CONKLIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGDALE
Practice Address - State:NY
Practice Address - Zip Code:11735-2501
Practice Address - Country:US
Practice Address - Phone:516-526-5196
Practice Address - Fax:631-351-4049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031523-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty