Provider Demographics
NPI:1124568068
Name:WHOLE HEALTH KINETIX
Entity Type:Organization
Organization Name:WHOLE HEALTH KINETIX
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BS, MPAS, PA-C
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:STEPINOFF
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:713-703-9852
Mailing Address - Street 1:14800 QUORUM DR STE 560
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75254-7679
Mailing Address - Country:US
Mailing Address - Phone:469-547-1700
Mailing Address - Fax:
Practice Address - Street 1:14800 QUORUM DR STE 560
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75254-7679
Practice Address - Country:US
Practice Address - Phone:469-547-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-25
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty