Provider Demographics
NPI:1922396373
Name:KAH PREMIUM PHYSICAL THERAPY P.C.
Entity Type:Organization
Organization Name:KAH PREMIUM PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:PT,DPT
Authorized Official - Phone:631-675-6262
Mailing Address - Street 1:1071 ROUTE 25A
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1922
Mailing Address - Country:US
Mailing Address - Phone:631-675-6262
Mailing Address - Fax:631-675-6264
Practice Address - Street 1:1071 ROUTE 25A
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1922
Practice Address - Country:US
Practice Address - Phone:631-675-6262
Practice Address - Fax:631-675-6264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty