Provider Demographics
NPI:1184020638
Name:KINEMATICS PHYSICAL THERAPY AND SPORTS PERFORMANCE INC
Entity Type:Organization
Organization Name:KINEMATICS PHYSICAL THERAPY AND SPORTS PERFORMANCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:HARU
Authorized Official - Last Name:FUJITA
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, OCS
Authorized Official - Phone:909-957-0557
Mailing Address - Street 1:25050 ACORN CT
Mailing Address - Street 2:
Mailing Address - City:TEMESCAL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92883-8455
Mailing Address - Country:US
Mailing Address - Phone:909-957-0557
Mailing Address - Fax:
Practice Address - Street 1:1761 3RD ST
Practice Address - Street 2:SUITE 105
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2678
Practice Address - Country:US
Practice Address - Phone:909-957-0557
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-11
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365342251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty