Provider Demographics
NPI:1164137832
Name:KINECTIVE FITNESS CLUB LLC
Entity Type:Organization
Organization Name:KINECTIVE FITNESS CLUB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:KERCHER
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:915-260-9895
Mailing Address - Street 1:1020 BELVIDERE ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2426
Mailing Address - Country:US
Mailing Address - Phone:915-260-9895
Mailing Address - Fax:
Practice Address - Street 1:1020 BELVIDERE ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-2426
Practice Address - Country:US
Practice Address - Phone:915-260-9895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy