Basic Information
| Provider Information | |||||||||
| NPI: | 1326132820 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KINETIC PHYSICAL THERAPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 163 POTTSTOWN PIKE | ||||||||
| Address2: | |||||||||
| City: | CHESTER SPRINGS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194259518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104586464 | ||||||||
| FaxNumber: | 6104586465 | ||||||||
| Practice Location | |||||||||
| Address1: | 163 POTTSTOWN PIKE | ||||||||
| Address2: | |||||||||
| City: | CHESTER SPRINGS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194259518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104586464 | ||||||||
| FaxNumber: | 6104586465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 06/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | RODIA | ||||||||
| AuthorizedOfficialFirstName: | DARREN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAL THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 6104586464 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | PT016366 | PA | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.