Provider Demographics
NPI:1619581758
Name:MYOKINETIC PT LLC
Entity Type:Organization
Organization Name:MYOKINETIC PT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVE
Authorized Official - Middle Name:
Authorized Official - Last Name:MADARANG
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:828-490-1567
Mailing Address - Street 1:135 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-0148
Mailing Address - Country:US
Mailing Address - Phone:828-490-1567
Mailing Address - Fax:
Practice Address - Street 1:135 N RIVER RD
Practice Address - Street 2:
Practice Address - City:FLETCHER
Practice Address - State:NC
Practice Address - Zip Code:28732-0148
Practice Address - Country:US
Practice Address - Phone:828-490-1567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-05
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty