Provider Demographics
NPI:1376951822
Name:KINETIX PROFESSIONAL MANAGEMENT, INC.
Entity Type:Organization
Organization Name:KINETIX PROFESSIONAL MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROX
Authorized Official - Middle Name:JOACUIN
Authorized Official - Last Name:LUKAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:646-707-1957
Mailing Address - Street 1:13324 SANFORD AVE APT 9E
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-3624
Mailing Address - Country:US
Mailing Address - Phone:646-707-1957
Mailing Address - Fax:
Practice Address - Street 1:8716 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4419
Practice Address - Country:US
Practice Address - Phone:646-707-1957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31626261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy