KODIAK PHYSICAL THERAPY LLC
NPI 1912725904
Physical Therapist in Holmdel, NJ

Active since September 30, 2024
702 N BEERS ST STE 3, HOLMDEL, NJ 07733(732) 724-3720(732) 724-3723 Get Directions Write a Review

NPPES record last updated: September 30, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Kodiak Physical Therapy Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KODIAK PHYSICAL THERAPY LLC (NPI 1912725904), doing business as Kodiak Physical Therapy, is a healthcare organization registered as a physical therapist in Holmdel, New Jersey and active in the NPI registry since September 2024. The organization lists Dov Iwaniski, Owner, as its authorized official.

NPPES Registry Identity

NPI1912725904
Entity TypeOrganization
Primary Taxonomy225100000X
Legal Business NameKODIAK PHYSICAL THERAPY LLC
Location Address702 N BEERS ST STE 3Holmdel, NJ 07733-1510
Mailing Address12 Taft AveLakewood, NJ 08701-5664
Fax(732) 724-3723
Organization SubpartNo
Authorized OfficialDov IwaniskiOwner · (732) 724-3720
Enumeration DateSeptember 30, 2024
NPPES CertifiedSeptember 30, 2024
✔ NPI 1912725904 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysical TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
Taxonomy Code225100000X
Definition
Physical therapists (PTs) are licensed health care professionals who diagnose and treat individuals of all ages, from newborns to the very oldest, who have medical problems or other health-related conditions that limit their abilities to move and perform functional activities in their daily lives. PTs examine each individual and develop a plan using treatment techniques to promote the ability to move, reduce pain, restore function, and prevent disability. In addition, PTs work with individuals to prevent the loss of mobility before it occurs by developing fitness- and wellness-oriented programs for healthier and more active lifestyles. PTs:
  • Diagnose and manage movement dysfunction and enhance physical and functional abilities.
  • Restore, maintain, and promote not only optimal physical function but optimal wellness and fitness and optimal quality of life as it relates to movement and health.
  • Prevent the onset, symptoms, and progression of impairments, functional limitations, and disabilities that may result from diseases, disorders, conditions, or injuries.
  • Treat conditions of the musculoskeletal, neuromuscular, cardiovascular, pulmonary, and/or integumentary systems.
  • Address the negative effects attributable to unique personal and environmental factors as they relate to human performance.
PTs provide care for people in a variety of settings, including hospitals, private practices, outpatient clinics, home health agencies, schools, sports and fitness facilities, work settings, and nursing homes. State licensure is required in each state in which a PT practices.
702 N BEERS ST STE 3, Holmdel, NJ 07733

Other Names 1

Doing Business AsKodiak Physical Therapy

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kodiak Physical Therapy Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Kodiak Physical Therapy LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Physical Therapist in Private Practice
NPI 1164726394
12 TAFT AVE
Lakewood, NJ 08701
(732) 367-7391
✔ Accepts Medicare24 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kodiak Physical Therapy LLC's NPI number?

The NPI number for Kodiak Physical Therapy LLC is 1912725904. It was assigned to this organization in the NPPES registry on September 30, 2024. The provider is doing business as Kodiak Physical Therapy.

Where is Kodiak Physical Therapy LLC located?

Kodiak Physical Therapy LLC is located at 702 N Beers St Ste 3, Holmdel, NJ 07733. The listed phone number is (732) 724-3720.

What is Kodiak Physical Therapy LLC's specialty?

The primary specialty registered for this NPI is Physical Therapist with taxonomy code 225100000X.

Is Kodiak Physical Therapy LLC enrolled in Medicare?

Yes. Kodiak Physical Therapy LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Kodiak Physical Therapy LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Physical Therapist in Private Practice) reassigns their Medicare billing to Kodiak Physical Therapy LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Kodiak Physical Therapy LLC was last updated on September 30, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.