Kenneth Chang-Hay Van, PT, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

029836 Issued in NY

Practice address

115 W 30TH St RM 502
New York, NY 10001-4074

Phone

(631) 213-2394

Fax

(212) 898-0470

NPI assigned

Oct 11, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Creighton University School of Medicine, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Revolution Physical Therapy PLLCGroup PAC ID 8820408388, 2 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.

• Revolution Physical Therapy PLLC

  • Physical Therapist
  • New York, NY
  • NPI 1689281842
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1192060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1275721524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 W 30TH ST RM 502",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100014074",
            "telephone_number": "631-213-2394",
            "fax_number": "212-898-0470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 W 30TH ST RM 502",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100014074",
            "telephone_number": "631-213-2394",
            "fax_number": "212-898-0470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN",
        "first_name": "KENNETH",
        "middle_name": "CHANG-HAY",
        "credential": "PT, DPT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-11",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "029836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1275721524",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kvan@revolutionpt.net",
            "affiliation": "N",
            "endpointDescription": "email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "115 W 30th St Rm 502",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100014074",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Laura Anne Van Wyk, LCSW
• Kimberly J Van Zee, MD
• Brian Van, PHARMD
• David Charles Van, MD
• Julia Van, PHARMD
• Minh-Tom Van, DDS
• Vanaa Tech LLC
• Jade Vanacore, PA-C
• Equarm Vanager, LMHC
• Jill Marie Vanak, ACNP-BC

• Physical Therapist in New York, NY
• Providers in New York, NY by specialty
• Physical Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2024; 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.