Provider Demographics
NPI:1215483797
Name:HOWELL, KADEEM ANTHONY (DPT)
Entity type:Individual
Prefix:DR
First Name:KADEEM
Middle Name:ANTHONY
Last Name:HOWELL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 MERSEREAU AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1106
Mailing Address - Country:US
Mailing Address - Phone:516-236-7273
Mailing Address - Fax:914-445-0143
Practice Address - Street 1:2 MERSEREAU AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1106
Practice Address - Country:US
Practice Address - Phone:516-236-7273
Practice Address - Fax:914-445-0143
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY040549225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05985942Medicaid