Provider Demographics
NPI:1992233357
Name:KINETICS PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:KINETICS PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEACHY
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-292-3130
Mailing Address - Street 1:1440 OUTLOOK AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1157
Mailing Address - Country:US
Mailing Address - Phone:917-292-3130
Mailing Address - Fax:
Practice Address - Street 1:1440 OUTLOOK AVE APT 1
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1157
Practice Address - Country:US
Practice Address - Phone:917-292-3130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
NY20513252Y00000X
NY020513252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No251E00000XAgenciesHome Health