Provider Demographics
NPI:1386734218
Name:FOXX, KENNETH C II (PT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:C
Last Name:FOXX
Suffix:II
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:313 S LODER AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-6031
Mailing Address - Country:US
Mailing Address - Phone:607-748-3703
Mailing Address - Fax:607-748-5130
Practice Address - Street 1:313 S LODER AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-6031
Practice Address - Country:US
Practice Address - Phone:607-748-3703
Practice Address - Fax:607-748-5130
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005666-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
53931BMedicare PIN
0503630001Medicare NSC
1386734218Medicare PIN