Basic Information
| Provider Information | |||||||||
| NPI: | 1083652069 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KINETIC ENERGY PHYSICAL THERAPY PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 883299 | ||||||||
| Address2: | |||||||||
| City: | STEAMBOAT SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804883299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708798026 | ||||||||
| FaxNumber: | 9708798046 | ||||||||
| Practice Location | |||||||||
| Address1: | 1585 MID VALLEY DR | ||||||||
| Address2: | #3 | ||||||||
| City: | STEAMBOAT SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804879098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708798026 | ||||||||
| FaxNumber: | 9708798046 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 08/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | RABANAL | ||||||||
| AuthorizedOfficialFirstName: | MARCO | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9708798026 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251X0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Orthopedic |
No ID Information.