Provider Demographics
NPI:1427279520
Name:KEARNEY, KIM MARIA (PT)
Entity type:Individual
Prefix:MS
First Name:KIM
Middle Name:MARIA
Last Name:KEARNEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 MULBERRY ST
Mailing Address - Street 2:#6
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10012-4159
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:236 MULBERRY ST
Practice Address - Street 2:#6
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10012-4159
Practice Address - Country:US
Practice Address - Phone:212-925-2812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0117721225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQL7121Medicare ID - Type UnspecifiedPHYSICAL THERAPY