Basic Information
Provider Information | |||||||||
NPI: | 1942631080 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | KINEMATIC CONCPETS PHYSICAL THERAPY & SPORTS REHAB, PLLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | MOMENTUM PHYSICAL THERAPY & SPORTS REHAB | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8627 CINNAMON CREEK DR | ||||||||
Address2: | SUITE 402 | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 782401480 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2106958731 | ||||||||
FaxNumber: | 2105980432 | ||||||||
Practice Location | |||||||||
Address1: | 20821 US HIGHWAY 281 N | ||||||||
Address2: | SUITE 110 | ||||||||
City: | SAN ANTONIO | ||||||||
State: | TX | ||||||||
PostalCode: | 782587593 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2106104480 | ||||||||
FaxNumber: | 2103340948 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/27/2013 | ||||||||
LastUpdateDate: | 11/27/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MALFER | ||||||||
AuthorizedOfficialFirstName: | JOHN MALFER | ||||||||
AuthorizedOfficialMiddleName: | P | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT/CO-OWNER | ||||||||
AuthorizedOfficialTelephone: | 2106958731 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | PT | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 647890009 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |   |
No ID Information.