Provider Demographics
NPI:1144847054
Name:KINECT THERAPY SERVICES
Entity type:Organization
Organization Name:KINECT THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OMGR
Authorized Official - Prefix:
Authorized Official - First Name:LLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:DALEY BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:OTR/L
Authorized Official - Phone:772-772-7082
Mailing Address - Street 1:596 SE NOME DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-8944
Mailing Address - Country:US
Mailing Address - Phone:772-301-4458
Mailing Address - Fax:
Practice Address - Street 1:596 SE NOME DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-8944
Practice Address - Country:US
Practice Address - Phone:772-301-4458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty