Provider Demographics
NPI:1568830180
Name:CORE KINETICS PHYSICAL THERAPY, LLC
Entity Type:Organization
Organization Name:CORE KINETICS PHYSICAL THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO/PHYSICAL THERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:ELAM
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT
Authorized Official - Phone:225-719-1957
Mailing Address - Street 1:PO BOX 1505
Mailing Address - Street 2:
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-1505
Mailing Address - Country:US
Mailing Address - Phone:225-719-1957
Mailing Address - Fax:
Practice Address - Street 1:1673 E MOUNT PLEASANT RD
Practice Address - Street 2:UNIT F
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-5917
Practice Address - Country:US
Practice Address - Phone:225-719-1957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy