Provider Demographics
NPI:1366543019
Name:KURTZ, KEVIN (PT, MPT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:
Last Name:KURTZ
Suffix:
Gender:M
Credentials:PT, MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WORLDS FAIR DRIVE
Mailing Address - Street 2:SUITE M
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873
Mailing Address - Country:US
Mailing Address - Phone:732-356-5363
Mailing Address - Fax:732-356-5364
Practice Address - Street 1:14 WORLDS FAIR DRIVE
Practice Address - Street 2:SUITE M
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873
Practice Address - Country:US
Practice Address - Phone:732-356-5363
Practice Address - Fax:732-356-5364
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00517400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ085857THYMedicare PIN