Provider Demographics
NPI:1114978376
Name:KINETIC PHYSICAL THERAPY, INC
Entity Type:Organization
Organization Name:KINETIC PHYSICAL THERAPY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST, MSPT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SODERO
Authorized Official - Suffix:
Authorized Official - Credentials:MSPT
Authorized Official - Phone:410-573-9930
Mailing Address - Street 1:132 HOLIDAY CT
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7005
Mailing Address - Country:US
Mailing Address - Phone:410-573-9930
Mailing Address - Fax:410-573-9932
Practice Address - Street 1:132 HOLIDAY CT
Practice Address - Street 2:SUITE 203
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7005
Practice Address - Country:US
Practice Address - Phone:410-573-9930
Practice Address - Fax:410-573-9932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-13
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD20542261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD799MMedicare ID - Type Unspecified