Provider Demographics
NPI:1003097007
Name:PHYSIOKINETICS INC
Entity Type:Organization
Organization Name:PHYSIOKINETICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:561-616-7664
Mailing Address - Street 1:4393 LAKE TAHOE CIR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BCH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-7872
Mailing Address - Country:US
Mailing Address - Phone:561-616-7664
Mailing Address - Fax:
Practice Address - Street 1:4393 LAKE TAHOE CIR
Practice Address - Street 2:
Practice Address - City:WEST PALM BCH
Practice Address - State:FL
Practice Address - Zip Code:33409-7872
Practice Address - Country:US
Practice Address - Phone:561-616-7664
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-18
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health