Provider Demographics
NPI:1346329604
Name:MAGNER, KATHLEEN (DPT)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:MAGNER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MERRICK RD
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2621
Mailing Address - Country:US
Mailing Address - Phone:516-599-8734
Mailing Address - Fax:516-599-8730
Practice Address - Street 1:225 MERRICK RD
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-2621
Practice Address - Country:US
Practice Address - Phone:516-599-8734
Practice Address - Fax:516-599-8730
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0255311225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A400025767Medicare UPIN