Provider Demographics
NPI:1689953598
Name:TRINCHETTO, KIM MICHELE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:MICHELE
Last Name:TRINCHETTO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 FLOYD LN
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-5305
Mailing Address - Country:US
Mailing Address - Phone:631-864-7632
Mailing Address - Fax:
Practice Address - Street 1:4 FLOYD LN
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-5305
Practice Address - Country:US
Practice Address - Phone:631-864-7632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023581225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist