NPIMap

Organization Active NPI

Kah Premium Physical Therapy P.C.

  • Physical Therapist
  • Stony Brook, NY
National Provider Identifier
1922396373
Registry record updated Jul 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
KAH PREMIUM PHYSICAL THERAPY P.C.
Practice address
1071 Route 25a
Stony Brook, NY 11790-1922
Phone
(631) 675-6262
Fax
(631) 675-6264
NPI assigned
Jul 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2011

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

Authorized official

Name
Mrs. Kimberly Ann Harris, PT,DPTNPI 1598901746
Title
President/Owner
Phone
(631) 675-6262

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

1071 Route 25a
Stony Brook, NY 11790-1922

Mailing address

1071 Route 25a
Stony Brook, NY 11790-1922
Phone (631) 675-6262

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111020000244 NY Part B Supplier - Physical/Occupational Therapy Group in Private Practice 2961674791 Receives reassigned benefits from 5 practitioners
Practice locations: Shoreham, NY; Stony Brook, NY

National Provider Directory

National Provider Directory

Locations

97 Main St
Ste H
Stony Brook, NY 11790
Phone (631) 751-6680

1071 Route 25A
Stony Brook, NY 11790
Phone (631) 675-6262

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1311033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311033600000",
    "number": "1922396373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1071 ROUTE 25A",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117901922",
            "telephone_number": "631-675-6262",
            "fax_number": "631-675-6264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1071 ROUTE 25A",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117901922",
            "telephone_number": "631-675-6262",
            "fax_number": "631-675-6264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KAH PREMIUM PHYSICAL THERAPY P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-19",
        "last_updated": "2011-07-19",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "631-675-6262",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PT,DPT"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.