Provider Demographics
NPI:1497993257
Name:SCIBILIA, KATHLEEN ELLEN (PT)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ELLEN
Last Name:SCIBILIA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:ELLEN
Other - Last Name:KERNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:36 PINETREE LN
Mailing Address - Street 2:
Mailing Address - City:ROSLYN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11577-2420
Mailing Address - Country:US
Mailing Address - Phone:516-626-1569
Mailing Address - Fax:516-626-1569
Practice Address - Street 1:36 PINETREE LN
Practice Address - Street 2:
Practice Address - City:ROSLYN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11577-2420
Practice Address - Country:US
Practice Address - Phone:516-626-1569
Practice Address - Fax:516-626-1569
Is Sole Proprietor?:No
Enumeration Date:2009-01-31
Last Update Date:2009-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003022-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist