Provider Demographics
NPI:1649797820
Name:KAIZEN PHYSICAL THERAPY P.L.L.C.
Entity type:Organization
Organization Name:KAIZEN PHYSICAL THERAPY P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BONIFACIO
Authorized Official - Middle Name:
Authorized Official - Last Name:WENCESLAO
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:845-541-2230
Mailing Address - Street 1:26 COOPER RD APT 715
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-1670
Mailing Address - Country:US
Mailing Address - Phone:845-541-2230
Mailing Address - Fax:
Practice Address - Street 1:26 COOPER RD APT 715
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603
Practice Address - Country:US
Practice Address - Phone:845-541-2230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy