Provider Demographics
NPI:1497764807
Name:MOTA, KERY (PT)
Entity Type:Individual
Prefix:
First Name:KERY
Middle Name:
Last Name:MOTA
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 1:66 LOUISA ST # 1F
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-3012
Mailing Address - Country:US
Mailing Address - Phone:978-884-4830
Mailing Address - Fax:
Practice Address - Street 1:521 5TH AVE
Practice Address - Street 2:C/O EQIUNOX FITNESS CLUB
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10175-0003
Practice Address - Country:US
Practice Address - Phone:212-692-9558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY006270-1OtherLICSENSE NUMBER