Provider Demographics
NPI:1811271299
Name:KINETOREHAB PHYSICAL THERAPY PLLC
Entity type:Organization
Organization Name:KINETOREHAB PHYSICAL THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST / OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:PALABAN
Authorized Official - Last Name:AGAPITO
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:212-365-4237
Mailing Address - Street 1:3201 GRAND CONCOURSE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10468-1247
Mailing Address - Country:US
Mailing Address - Phone:718-365-3747
Mailing Address - Fax:718-365-3749
Practice Address - Street 1:3201 GRAND CONCOURSE
Practice Address - Street 2:SUITE 1A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10468-1247
Practice Address - Country:US
Practice Address - Phone:718-365-3747
Practice Address - Fax:718-365-3749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028117-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY028117OtherLICENSE