Individual
KEVIN PHELAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
94 W MAIN ST, BAY SHORE, NY 11706-8365
(631) 983-3724
Mailing address
576 BROADHOLLOW RD STE PROEX, MELVILLE, NY 11747-5002
(631) 359-5859
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
007659
—
Other
Enumeration date
11/24/2021
Last updated
11/24/2021
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