Provider Demographics
NPI:1295805612
Name:MAYKISH, KIMBERLY J (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:J
Last Name:MAYKISH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:JOY
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:19 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:SHERBURNE
Mailing Address - State:NY
Mailing Address - Zip Code:13460
Mailing Address - Country:US
Mailing Address - Phone:607-674-6262
Mailing Address - Fax:607-674-6263
Practice Address - Street 1:19 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SHERBURNE
Practice Address - State:NY
Practice Address - Zip Code:13460
Practice Address - Country:US
Practice Address - Phone:607-674-6262
Practice Address - Fax:607-674-6263
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY025420-1208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1629096805OtherACT PHYSICAL THERAPY NPI
NY205143326OtherACT PT TAX ID