Provider Demographics
NPI:1043342504
Name:KINETIC PHYSICAL THERAPY SPECIALISTS, INC.
Entity Type:Organization
Organization Name:KINETIC PHYSICAL THERAPY SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:ULMER
Authorized Official - Suffix:JR
Authorized Official - Credentials:PT
Authorized Official - Phone:815-351-1621
Mailing Address - Street 1:11920 OAK CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-6728
Mailing Address - Country:US
Mailing Address - Phone:815-351-1621
Mailing Address - Fax:
Practice Address - Street 1:11920 OAK CREEK PKWY
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-6728
Practice Address - Country:US
Practice Address - Phone:815-351-1621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL70012444225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty