Individual
MR. KENNETH AIDEN LEACOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
233 W 139TH ST, NEW YORK, NY 10030-2104
(212) 283-6095
(212) 283-6095
Mailing address
233 W 139TH ST, NEW YORK, NY 10030-2104
(212) 283-6095
(212) 234-5237
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
007365
NY
2251X0800X
Orthopedic Physical Therapist
Primary
007365
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007365
P.T. LICENCE
NY
Enumeration date
12/27/2005
Last updated
09/11/2025
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