Provider Demographics
NPI:1447099254
Name:KIEMBOCK, CALEIGH MARIE (PT, DPT)
Entity type:Individual
Prefix:DR
First Name:CALEIGH
Middle Name:MARIE
Last Name:KIEMBOCK
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 WATER MILL TOWD RD
Mailing Address - Street 2:
Mailing Address - City:WATER MILL
Mailing Address - State:NY
Mailing Address - Zip Code:11976-2422
Mailing Address - Country:US
Mailing Address - Phone:631-377-8844
Mailing Address - Fax:
Practice Address - Street 1:760 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WATER MILL
Practice Address - State:NY
Practice Address - Zip Code:11976-2600
Practice Address - Country:US
Practice Address - Phone:631-812-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist