Provider Demographics
NPI:1629096805
Name:KIMBERLY MAYKISH, PT
Entity Type:Organization
Organization Name:KIMBERLY MAYKISH, PT
Other - Org Name:ACT PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:MAYKISH
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:607-316-2582
Mailing Address - Street 1:287 TRACY RD
Mailing Address - Street 2:
Mailing Address - City:SHERBURNE
Mailing Address - State:NY
Mailing Address - Zip Code:13460
Mailing Address - Country:US
Mailing Address - Phone:607-316-2582
Mailing Address - Fax:
Practice Address - Street 1:287 TRACY RD
Practice Address - Street 2:
Practice Address - City:SHERBURNE
Practice Address - State:NY
Practice Address - Zip Code:13460-2619
Practice Address - Country:US
Practice Address - Phone:607-316-2582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025420-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty