Provider Demographics
NPI:1972701654
Name:KLB PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:KLB PHYSICAL THERAPY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:W
Authorized Official - Last Name:HORN
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:212-675-3447
Mailing Address - Street 1:119 WEST 23RD STREET
Mailing Address - Street 2:SUITE 1002
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6341
Mailing Address - Country:US
Mailing Address - Phone:212-675-3447
Mailing Address - Fax:212-243-5213
Practice Address - Street 1:119 WEST 23RD STREET
Practice Address - Street 2:SUITE 1002
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6341
Practice Address - Country:US
Practice Address - Phone:212-675-3447
Practice Address - Fax:212-243-5213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020989208100000X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY020989OtherLICENSE