Provider Demographics
NPI:1902059462
Name:KID, KAREN MARIE (MS)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:KID
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:530 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-7707
Mailing Address - Country:US
Mailing Address - Phone:845-621-1400
Mailing Address - Fax:845-621-1133
Practice Address - Street 1:530 ROUTE 6
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-7707
Practice Address - Country:US
Practice Address - Phone:845-621-1400
Practice Address - Fax:845-621-1133
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013833-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics