Provider Demographics
NPI:1801055272
Name:SCHAPPE, KENNETH DAVID (LMT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:DAVID
Last Name:SCHAPPE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:12411-0236
Mailing Address - Country:US
Mailing Address - Phone:845-691-3500
Mailing Address - Fax:845-691-3500
Practice Address - Street 1:280 STATE ROUTE 299
Practice Address - Street 2:SUITE #2
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528
Practice Address - Country:US
Practice Address - Phone:845-691-3500
Practice Address - Fax:845-691-3500
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-02
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3622225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist