Provider Demographics
NPI:1336100015
Name:KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB
Entity Type:Organization
Organization Name:KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB
Other - Org Name:MOMENTUM PHYSICAL THERAPY & SPORTS REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO / CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ELMS
Authorized Official - Suffix:
Authorized Official - Credentials:MPT, OCS, FAAOPMT
Authorized Official - Phone:210-372-9600
Mailing Address - Street 1:12952 BANDERA RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4689
Mailing Address - Country:US
Mailing Address - Phone:210-695-2682
Mailing Address - Fax:210-598-0432
Practice Address - Street 1:12952 BANDERA RD
Practice Address - Street 2:SUITE 107
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4689
Practice Address - Country:US
Practice Address - Phone:210-372-9600
Practice Address - Fax:210-372-9923
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KINEMATIC CONCEPTS PHYSICAL THERAPY & SPORTS REHAB, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-31
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX647890000225100000X
TX647890002225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0084HNOtherBLUE CROSS BLUE SHIELD
TX1543670-01Medicaid
TX1543670-01Medicaid