Provider Demographics
NPI:1255382875
Name:KINETIC SPORTS PHYSICAL THERAPY P.C.
Entity type:Organization
Organization Name:KINETIC SPORTS PHYSICAL THERAPY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:RODRIGO
Authorized Official - Last Name:DINGLASAN
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-534-5778
Mailing Address - Street 1:115 E 86TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-1057
Mailing Address - Country:US
Mailing Address - Phone:212-534-5778
Mailing Address - Fax:212-534-9397
Practice Address - Street 1:115 E 86TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1057
Practice Address - Country:US
Practice Address - Phone:212-534-5778
Practice Address - Fax:212-534-9397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023483225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ8WPT1Medicare PIN