Provider Demographics
NPI:1518401744
Name:AMMONIUS, KERLOS (PT)
Entity Type:Individual
Prefix:
First Name:KERLOS
Middle Name:
Last Name:AMMONIUS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 BROADHOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-5002
Mailing Address - Country:US
Mailing Address - Phone:631-359-5856
Mailing Address - Fax:631-396-0865
Practice Address - Street 1:8002 KEW GARDENS RD FL 4
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3604
Practice Address - Country:US
Practice Address - Phone:718-263-7500
Practice Address - Fax:718-263-7502
Is Sole Proprietor?:No
Enumeration Date:2016-12-07
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037321-1174400000X
NY037321225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No174400000XOther Service ProvidersSpecialist