Kenneth Micko, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PT40QA01024400 Issued in NJ

Practice address

620 State Route 35
Middletown, NJ 07748-4224

Phone

(732) 671-9560

NPI assigned

May 3, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Bridgeway Care at Home LLCGroup PAC ID 6406198373, 39 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bridgeway Care at Home, LLC

  • Geriatric Physical Therapist
  • Bridgewater, NJ
  • NPI 1104383421
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1114149382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 STATE ROUTE 35",
            "city": "MIDDLETOWN",
            "state": "NJ",
            "postal_code": "077484224",
            "telephone_number": "732-671-9560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 STATE ROUTE 35",
            "city": "MIDDLETOWN",
            "state": "NJ",
            "postal_code": "077484224",
            "telephone_number": "732-671-9560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKO",
        "first_name": "KENNETH",
        "name_prefix": "Mr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NJ",
            "license": "PT40QA01024400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Memorial Sloan Kettering Monmouth
• Eric James Mendez
• Crystal Meyerson
• Michael E Keller DMD LLC
• Nicole Mickendrow
• Middletown Dental Care PA
• Middletown Emergency Medical Services Inc
• Middletown Family Dental LLC
• Middletown Foot & Ankle LLC
• Middletown Oral and Maxillofacial Surgery Associates LLC

• Physical Therapist in Middletown, NJ
• Providers in Middletown, NJ by specialty
• Physical Therapist in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.