Provider Demographics
NPI:1427590611
Name:EC KINETIC PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:EC KINETIC PHYSICAL THERAPY, LLC
Other - Org Name:EC KINETIC PHYSICAL THERAPY AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR OF PHYSICAL THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:CHERRY ANN
Authorized Official - Middle Name:APAGA
Authorized Official - Last Name:MINESES
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:201-532-5911
Mailing Address - Street 1:748 US HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-3401
Mailing Address - Country:US
Mailing Address - Phone:201-532-5911
Mailing Address - Fax:
Practice Address - Street 1:748 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-3401
Practice Address - Country:US
Practice Address - Phone:201-532-5911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-05
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01221500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ114589Medicare UPIN