Provider Demographics
NPI:1467882498
Name:KINETIC POTENTIAL PHYSICAL THERAPY, P.C.
Entity Type:Organization
Organization Name:KINETIC POTENTIAL PHYSICAL THERAPY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:424-254-6203
Mailing Address - Street 1:10739 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2219
Mailing Address - Country:US
Mailing Address - Phone:424-260-5778
Mailing Address - Fax:310-775-4342
Practice Address - Street 1:10739 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2219
Practice Address - Country:US
Practice Address - Phone:424-260-5778
Practice Address - Fax:310-775-4342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-12
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty